Outcome of Non-invasive Respiratory Support in Pediatric High Dependency Units for acute respiratory distress.

Abstract

Background: Noninvasive respiratory support (NRS) is widely used in pediatric intensive care units (PICUs). However, there is limited experience regarding the utilization of NRS in non-PICU settings. We aimed to evaluate the success rate of NRS in pediatric high-dependency units (PHDU), identify predictors of NRS failure, quantify adverse events and assess outcomes. Methods: We included infants and children (older than 7 days to less than 13 years old) admitted to PHDU in two tertiary hospitals in Oman for acute respiratory distress over a 19-month period. Collected data included diagnosis, type and duration of NRS, adverse events, and the need for PICU transfer or invasive ventilation. Results: 299 children were included, with a median age of 7 months (IQR:3-25 months) and a median weight of 6.1 kg (IQR: 4.3-10.5 kg). Bronchiolitis (37.5%), pneumonia (34.1%), and asthma (12.7%) were the most frequent diagnoses. Median NRS duration was two days (IQR: 1-3 days). At baseline, median SpO2 was 96% (IQR: 90-99%), median pH was 7.36 (IQR: 7.31-7.41), and median PCO2 was 44 mmHg (IQR: 36-53 mmHg). Overall, 234(78.3%) children were successfully managed in PHDU while 65 (21.7%) required transfer to PICU. 38(12.7%) needed invasive ventilation on a median time of 43.5 hours (IQR: 13.5-108 hours). On multivariate analysis, maximum FIO2 of > 0.5 (odds ratio [OR]: 4.494, 95% confidence interval [CI]: 1.357-14.886; P = 0.02) and PEEP of >7 cm H2O (OR: 3.368, 95% CI: 1.490-7.612; P = 0.004) were predictors for NRS failure. Significant apnea, cardiopulmonary resuscitation, and air leak syndrome were reported in 0.4%, 0.9%, and 0.9% of children, respectively. Conclusions: In our cohort, we found NRS in PHDU safe and effective; however, maximum FIO2 of > 0.5 post treatment and PEEP of >7 cm H2O were associated with NRS failure.