Success or failure of non-invasive positive pressure ventilation in children with acute respiratory failure. Could it be predicted?

Abstract

<b>Introduction: </b> Noninvasive ventilation (NIV) has been developed to reduce complications associated with invasive ventilation (IV). Failure of NIV and delay in endotracheal intubation can increase patients’ morbidity and mortality. Thus early determination of patients who are unlikely to benefit from NIV is crucial for their management. We aimed in this study to identify the early predictors of success of NIV in children with acute respiratory failure (ARF).<br /> <b>Material and methods: </b> Fifty patients with ARF who fulfilled the study selection criteria were ventilated non-invasively and were assessed initially for their severity of critical illness by the Pediatric Logistic Organ Dysfunction (PELOD) score. Clinical, gasometric, respiratory mechanics and oxygenation indices were assessed at 0, 30 and 60 min and 4 and 24 h from the start of NIV. The success group was identified by reduction in respiratory effort, reduction in oxygen demand, improvement in gasometric parameters, and avoidance of intubation.<br /> <b>Results</b>: Sixty-two percent of patients had successful NIV. Neither type of ARF nor patients’ demographics affected the outcome of NIV. The success rate was 80% among patients with mild to moderate acute respiratory distress syndrome (ARDS), 20% with severe ARDS, and 71.8% in patients with bronchopneumonia. Multivariate analysis revealed that baseline PELOD score of less than 14.5 ±2.7, SpO2/FiO2 ratio more than 208 ±57, oxygenation index (OI) 7 ±3.4 and mean airway pressure (MAP) 8.6 ±1.3 are independent predictors for success of NIV.<br /> <b>Conclusions</b>: The NIV is a promising respiratory support modality in pediatric ARF. Baseline degree of critical illness and saturation oxygenation indices together with MAP change after the 1st h from the NIV trial represented the best predictors of success of the trial in the current study.