P0437 / #2122: OUTCOMES OF NON-INVASIVE BI-LEVEL POSITIVE AIRWAY PRESSURE VENTILATION AS INITIAL MANAGEMENT OF ACUTE RESPIRATORY FAILURE IN PEDIATRIC CRITICAL CARE

Abstract

Aims & Objectives: To assess the outcomes of non-invasive bi-level positive airway pressure (BLPAP) ventilation as first-line therapy in children with acute respiratory failure (ARF). Methods: Design: A retrospective observational study. Setting: Pediatric Intensive Care Unit (PICU) of a university hospital. Patients: Eighty-seven patients subjected to non-invasive ventilation (NIV) as the initial management in a total of 92 ARF episodes were included, from July-2017 to June-2020. Each episode was treated as an independent event. Main Outcome Measures: We evaluated changes of heart rate, respiratory rate and SpO2/FiO2 ratio (S/F) at 3, 6, 12, and 24 hours after NIV onset, and compared patients using BLAP vs CPAP as first-line therapy. Results: BLPAP was started in 63 episodes (68.5%). Ten of 29 episodes (34.5%) that started CPAP were escalated to BLPAP. Baseline characteristics, initial physiologic parameters and severity score did not differ between groups. The S/F ratio increase at 6 hours was significantly greater in the BLPAP group (mean 48; CI95% 29-66) compared to the CPAP group (mean 21; CI95% -17-59; p=0,011). The trend continued over time, S/F ratio increase was greater in the BLPAP group at 24 hours. No difference was found in the intubation rate (BLPAP 4.4% vs CPAP 3.2%). The mean length of stay in the PICU was 1 day longer in the CPAP group, although it was not a significant difference. Conclusions: In children with ARF, the initial use of BLPAP rapidly improves the S/F ratio compared to CPAP. BLPAP as first-line therapy could be the best option for the management of patients with ARF.