Respiratory Failure In Children Research Articles

Longitudinal evaluation of pediatric respiratory infections.

Acute respiratory infections are the most common cause of under-five-year-old pediatric mortality worldwide. Due to a paucity of data, the impact of many respiratory viruses and their association with respiratory failure in children are unclear. We assessed single respiratory viral pathogens and their association with intubation, and secondly describe dual viral pathogens and viral-bacterial pathogens associations with intubation. This was a retrospective cross-sectional study of children (0-18 years old) admitted to the acute care unit and/or pediatric intensive care unit of an urban, quaternary children's hospital from November 1, 2013 to November 1, 2017. Patients with viral studies sent within 48h of admission were included. Associations of viral pathogens and intubation status were calculated using odds ratios (OR), 95% confidence intervals (CI) and p-values. There were 15,923 hospitalization encounters, with 634 (3.9%) requiring intubation. RSV and hMPV had increased odds for intubation, (aOR 1.80, 95% CI 1.50-2.18) and (aOR 1.59, 95% CI 1.13-2.24) respectively. Coinfection with RSV and adenovirus had increased odds of requiring intubation, (aOR 3.48, 95% CI 1.21-10.01). Contrary, coinfection with influenza A and RSV had no intubations. In the viral-bacterial coinfections model, there was an increased association with intubations for RSV and Streptococcus (aOR 9.34, 95% CI 4.21-20.71) and hMPV and Streptococcus (aOR 8.98, 95% CI 1.62-49.88). RSV and hMPV corresponded to the highest rates of intubations, and dual infections with RSV and adenovirus, RSV and Streptococcus, and hMPV and Streptococcus were associated with mechanical ventilation, revealing differences amongst the groups.

Long-term Neurocognitive Morbidity After a Single Episode of Respiratory Failure in Children

Long-term Neurocognitive Morbidity After a Single Episode of Respiratory Failure in Children

EFFECT OF NONINVASIVE VENTILATION ON OUTCOME OF PEDIATRIC PATIENTS WHO DEVELOP ACUTE RESPIRATORY FAILURE

TOPIC: Critical Care TYPE: Original Investigations PURPOSE: The utilization of noninvasive ventilation (NIV) has become popular as a supportive therapy in the treatment of acute respiratory failure in children. It has been proven to be effective in selected patients, and has decreased the incidence of endotracheal intubation, and the risk of acquiring ventilator-associated pneumonia, barotrauma, laryngeal swelling, and post-extubation vocal cord dysfunction. In the local setting, there is paucity of literature regarding the use of non -invasive ventilation in pediatrics, hence this study aims to determine its outcome and predictors of success, to fill gap in knowledge. METHODS: The study is a retrospective cross-sectional study that examined the outcomes and predictors of success of use of non- invasive ventilation in pediatric patients with acute respiratory failure. RESULTS: There were a total of 75 patients included in the study. Seventy three percent (n= 55) of patients had NIV success as an outcome while twenty seven percent (n= 20) of patient has NIV failure as an outcome. The average age of the participants 0.33 or 3.9 months. Seventy six percent (n= 57) were male, while twenty four percent (n=18) were female. Most of the patient had a normal nutritional status with an incidence of 50.6% (n= 38). The most common cardiac diagnosis of patients who were instituted with NIV are dextro transposition of the great arteries (46%) and ventricular septal defect (40.91%). The most common cause of respiratory failure of patients who were instituted with non- invasive ventilation are post extubation failure (64%); pulmonary congestion (54%) and pneumonia (53%).On multivariate analysis, the following factors namely 1) Presence of Pneumonia (p = 0.008); 2.) Presence of sepsis (p= 0.10); 3.) Having a severe respiratory distress prior to NIV ( p = 0.044) 4.) and using CPAP as the NIV mode (p= 0.003) were found to be significantly associated with NIV outcome. Specifically, it was found that patients with pneumonia were 97.72% less likely to have successful NIV and patients with presence of sepsis were 94.95% less likely to have successful NIV. In addition, patients with severe level of distress prior to NIV were 99.97% less likely to have successful NIV. Lastly, patients with CPAP NIV mode were 63.5 times more likely to have successful NIV compared to patients with BIPAP NIV mode. CONCLUSIONS: The use of non- invasive ventilation in patients with acute respiratory failure can be effective and can ultimately decrease the need for endotracheal intubation. However, caution with its use should be applied in patients with pneumonia, sepsis and severe level of respiratory distress, Knowledge regarding the efficacy and possible predictors of outcome of NIV use, can help in the prevention of pulmonary morbidity as well as in the improvement of management approach to children presenting with respiratory distress. CLINICAL IMPLICATIONS: This study evaluated the clinical indication, predictors and outcomes of non -invasive ventilation. The information gathered in this study will contribute to the existing pool of knowledge and will help the pediatricians to decide whether to initiate NIV or not. This study will also serve as a stepping stone to the pursuit of further studies about non- invasive ventilation. DISCLOSURES: No relevant relationships by JENNEYFER REZZA RUCKENBROD, source=Web Response

Manual external chest compression reverses respiratory failure in children with severe air trapping.

We report manual external chest compression (MECC) as an effective treatment for acute respiratory failure due to severe air trapping. In this retrospective study, we describe our experience with MECC administered to five children suffering from severe air trapping as a consequence of severe asthma or bronchiolitis. These children were admitted to the Pediatric Intensive Care Unit (PICU) with clinical and blood gases parameters compatible with acute respiratory failure. Before intubation MECC was performed. The results of blood gasses before, during, and after MECC showed gradual changes in PCO2 over time indicating the improvement in tidal volume and ventilation. Respiratory failure resolved in all five children within 4 h with no complications. The need for intubation and mechanical ventilation was avoided, and all children were discharged from the PICU within 48 h.

Acute Hypoxemic Respiratory Failure in Children at the Start of COVID-19 Outbreak: A Nationwide Experience.

Study design: This is a prospective, multicenter, and observational study with the aim of describing physiological characteristics, respiratory management, and outcomes of children with acute hypoxemic respiratory failure (AHRF) from different etiologies receiving invasive mechanical ventilation (IMV) compared with those affected by SARS-CoV-2. Methods and Main Results: Twenty-eight patients met the inclusion criteria: 9 patients with coronavirus disease 2019 (COVID-19) and 19 patients without COVID-19. Non-COVID-19 patients had more pre-existing comorbidities (78.9% vs. 44.4%) than COVID-19 patients. At AHRF onset, non-COVID-19 patients had worse oxygenation (PaO2/FiO2 = 95 mmHg (65.5–133) vs. 150 mmHg (105–220), p = 0.04), oxygenation index = 15.9 (11–28.4) vs. 9.3 (6.7–10.6), p = 0.01), and higher PaCO2 (48 mmHg (46.5–63) vs. 41 mmHg (40–45), p = 0.07, that remained higher at 48 h: 54 mmHg (43–58.7) vs. 41 (38.5–45.5), p = 0.03). In 12 patients (5 COVID-19 and 7 non-COVID-19), AHRF evolved to pediatric acute respiratory distress syndrome (PARDS). All non-COVID-19 patients had severe PARDS, while 3 out of 5 patients in the COVID-19 group had mild or moderate PARDS. Overall Pediatric Intensive Care Medicine (PICU) mortality was 14.3%. Conclusions: Children with AHRF due to SARS-CoV2 infection had fewer comorbidities and better oxygenation than patients with non-COVID-19 AHRF. In this study, progression to severe PARDS was rarely observed in children with COVID-19.

Efficacy of Noninvasive Ventilator in the Treatment of Severe Pneumonia Complicated with Acute Respiratory Failure in Children

Efficacy of Noninvasive Ventilator in the Treatment of Severe Pneumonia Complicated with Acute Respiratory Failure in Children

Evaluation of Clinical and Epidemiological Features of Patients Receiving High-Flow Nasal Cannula Oxygen Therapy in Pediatric Intensive Care Unit

Purpose: One of the respiratory supports in acute respiratory failure (ARF) is high-flow nasal cannula (HFNC) oxygen therapy, which is being increasingly used. In this study, we aimed to evaluate the patients with ARF who received HFNC oxygen therapy in pediatric intensive care unit (ICU). Material and Methods: The study was done retrospectively in 104 patients who were admitted to the pediatric ICU and received HFNC oxygen therapy between January 2015 and December 2017. Results: The median age of the patients participating in the study was 5 months. The most common cause of hospitalization was lower respiratory disease (97.1%) and 52.9% of the patients had type 1 respiratory failure. The median length of stay in the pediatric ICU was 7 days, while the median duration of HFNC oxygen therapy was 48 hours. Of the patients who received HFNC oxygen therapy, 28.8% were intubated. In patients who were intubated during HFNC oxygen therapy, the rates of having a chronic disease and chronic lung disease were significantly higher than those who were not intubated (p=0.001, p=0.033, respectively). In terms of complications, 8.7% of the patients had nasal skin damage caused by the cannula and pneumothorax developed in 1.9% of the patients. The rates of chronic diseases and congenital heart disease of the patients who were admitted to pediatric ICU and died after HFNC oxygen therapy were significantly higher than the survivors (p=0.043, p=0.003, respectively). Conclusion: The results of HFNC oxygen therapy, which is being increasingly used in the treatment of respiratory failure in children, are generally satisfactory. However, due to possible complications close monitoring is required during the application.

Outcomes of extracorporeal life support for respiratory failure in children with primary immunodeficiencies.

Extracorporeal Membrane Oxygenation (ECMO) may serve as a life-saving rescue therapy in critically ill children with respiratory failure. While survival rates of ECMO in children with secondary immunodeficiency is considered relatively poor, survival rates in children with primary immunodeficiencies (PID) has yet to be thoroughly investigated. Retrospective analysis of prospectively collected data from children (29 days-18 years old). PID patients were identified by using International Classification of Diseases (ICD) codes. Data were retrieved from Extracorporeal Life Support Organization Registry (1989-2018). ECMO for a pulmonary support indication. The survival-to-discharge rate was calculated and factors influencing outcomes were compared between survivors and non-survivors. A total of 73 eligible ECMO runs were included. The survival-to-discharge rate in pediatric PID patients was 45.2%. No differences were noted in survival based on type of immunodeficiency (p = 0.42) or decade of support (p = 0.98). There was no difference in the rate of pre-ECMO infection in survivors versus non-survivors (p = 0.69). The survival-to-discharge rate in patients with a culture positive infection during the ECMO run was 45.0% versus 45.3% in those with no infection (p = 0.98). In multivariate analysis, only cardiac complications (OR 5.09, 95% CI: 1.15-22.53), pulmonary complications (OR: 13.00, 95% CI: 1.20-141.25), and neurologic complications (OR: 9.86, 95% CI: 1.64-59.21) were independently associated with increased mortality. Children with a PID who require extracorporeal life support due to respiratory failure have a reasonable chance of survival and should be considered candidates for ECMO. The presence of a pre-ECMO infection should not be considered an ECMO contraindication.

Eosinophil Extracellular Traps in the Casts of Plastic Bronchitis Associated With Influenza Virus Infection

Plastic bronchitis (PB) is a rare pulmonary disease characterized by production of cohesive and branching casts that fill the airway. 1 Rubin B.K. Plastic bronchitis. Clin Chest Med. 2016; 37: 405-408 Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar PB is classified into two types based on differences in the mechanism of development. Lymphatic PB, sometimes called “classic,” is associated mainly with congenital heart diseases or lymphatic anomalies, in the development of which aberrant pulmonary lymphatics appear to play a major role. Nonlymphatic PB is associated mainly with respiratory diseases, in which inflammatory immune cells may play a role. We and others have reported that influenza A (H1N1) pdm09 virus infection causes PB, especially in patients with an allergy and/or asthma. 2 Uda K. Shoji K. Koyama-Wakai C. et al. Clinical characteristics of influenza virus-induced lower respiratory infection during the 2015 to 2016 season. J Infect Chemother. 2018; 24: 407-413 Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar ,3 Uchimura T. Mori M. Nariai A. Yokota S. Analysis of cases of severe respiratory failure in children with influenza (H1N1) 2009 infection in Japan. J Infect Chemother. 2012; 18: 59-65 Abstract Full Text PDF PubMed Scopus (10) Google Scholar Casts from some patients with PB due to influenza virus infection (Flu-PB) were composed of fibrin and such inflammatory immune cells as eosinophils and neutrophils. 4 Deng J. Zheng Y. Li C. Ma Z. Wang H. Rubin B.K. Plastic bronchitis in three children associated with 2009 influenza A(H1N1) virus infection. Chest. 2010; 138: 1486-1488 Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar These findings indicate that granulocytes, as well as an allergic status, are likely to be involved in the pathophysiologic condition of Flu-PB. However, the detailed mechanisms of how highly viscous casts are formed in patients with Flu-PB and the roles of granulocytes remain unclear.

High-frequency oscillatory ventilation in children: A systematic review and meta-analysis.

High-frequency oscillatory ventilation (HFOV) is an alternative mechanical ventilation mode proposed to reduce ventilator-induced lung injuries and improve clinical outcomes. The aim of this study was to determine the effects of HFOV compared to conventional mechanical ventilation (CMV) when used in children with hypoxemic respiratory failure. The literature search was conducted to identify all studies published before December 2020. Eligible studies included a population aged between 28 days and 18 years old, presented original data from randomized controlled trials (RCTs) or observational studies, compared the use of HFOV with CMV. Meta-analyses of the pooled data were performed by using random-effects models with inverse-variance weighting. A total of 11 studies (2605 cases) were included, most of them evaluating patients with acute respiratory distress syndrome. The mean age of participants was 8.2 months and the mean oxygenation index of those included in the RCTs was 24.4. The effect of HFOV on mortality was not significant, and clinically significant harm or benefit could not be excluded (risk ratio [RR], 0.93; 95% confidence interval [CI], 0.72 to 1.20). No significant difference between groups was found in duration of mechanical ventilation (-2.23; 95% CI, -5.07 to 0.61), treatment failure (RR, 0.28; 95% CI, 0.08 to 1.02), and occurrence of barotrauma (RR, 0.88; 95% CI, 0.39 to 1.99). The scarce evidence currently available does not allow us to conclude that HFOV has advantages over CMV and further studies are needed to clarify its role in the treatment of acute hypoxemic respiratory failure in children.

The impact of obstructive sleep apnea on bronchiolitis severity in children with Down syndrome

ObjectivesAcute bronchiolitis commonly causes respiratory failure in children ≤2 years, and is particularly severe in those with Down syndrome (DS). Obstructive sleep apnea (OSA), common in DS, is also associated with respiratory complications. However, it is unknown whether OSA is associated with worse outcomes in children with and without DS, hospitalized with bronchiolitis. We hypothesized that in children with bronchiolitis, OSA is associated with worse outcomes in those with DS, independent of DS-related comorbidities. MethodsHospital discharge records of children with bronchiolitis aged ≤2 years were obtained for 1997–2012 from the Kid's Inpatient Database. The primary outcome was invasive mechanical ventilation (IMV), and secondary outcomes were non-invasive mechanical ventilation (NIMV), length of hospital stay, and inflation-adjusted cost of hospitalization (IACH). Multivariable regression was conducted to ascertain the associations between OSA and primary and secondary outcomes accounting for DS-associated comorbidities. ResultsThere were 928,961 hospitalizations for bronchiolitis. The DS group with bronchiolitis (n = 8697) was more likely to have OSA [241 (2.77%) vs 1293 (0.14%), p < 0.001] compared to the non-DS group (n = 920,264). Multivariable logistic regression showed that OSA was associated with IMV (adjusted odds ratio [OR], 3.32 [95% CI 2.54–4.35], p < 0.0001) in all children with bronchiolitis; and in those with DS, it was associated with IMV (adjusted OR, 2.34 [95% CI 1.38–3.97], p = 0.002), NIMV (adjusted OR, 8.21 [95% CI 4.48–15.04], p < 0.0001) and IACH (adjusted β, 0.18 [95% CI 0.02–0.34], p = 0.031). ConclusionsOSA is independently associated with assisted ventilation in all children hospitalized with bronchiolitis, regardless of DS-associated comorbidities in those with DS. The severity of bronchiolitis in children with DS may be driven by the high prevalence of OSA.

Invasive and noninvasive ventilation strategies for acute respiratory failure in children with coronavirus disease 2019.

Severe Acute Respiratory Syndrome Coronavirus 2 presents as symptomatic coronavirus disease 2019 (COVID-19) disease in susceptible patients. Severe pediatric COVID-19 disease is rare, limiting potential data accumulation on associated respiratory failure in children. Pediatric intensivists and pulmonologists managing COVID-19 patients look to adult guidelines and pediatric-specific consensus statements to guide management. The purpose of this article is to review the current literature and recommended strategies for the escalation of noninvasive and invasive respiratory support for acute respiratory failure associated with COVID-19 disease in children. There are no prospective studies comparing COVID-19 treatment strategies in children. Adult and pediatric ventilation management interim guidance is based on evidence-based guidelines in non-COVID acute respiratory distress syndrome, with considerations of (1) noninvasive positive pressure ventilation versus high-flow nasal cannula and (2) high versus lower positive end expiratory pressure strategies related to lung compliance and potential lung recruitability. Management of acute respiratory failure from COVID-19 requires individualized titration of noninvasive and invasive ventilation modalities with consideration of preserved or compromised pulmonary compliance. Research regarding best practices in the management of pediatric severe COVID-19 with respiratory failure is lacking and is acutely needed as the pandemic surges and vaccination of the pediatric population will be delayed compared to adults.

P0387 / #787: VAPING ASSOCIATED LUNG DISEASE: A CASE PRESENTATION

Aims & Objectives: Vaping is an increasing alternative to smoking and widely considered a safe alternative. This case provides an example of a paediatric patient admitted to intensive care with an acute respiratory illness that presented a number of days after vaping. Methods: KB, a 14 year old, presented with abdominal pain and malaise. Her symptoms evolved to include dizziness, headache and nausea. Over 24 hours she developed worsening respiratory distress and hypoxia despite maximal high flow oxygen therapy.CXR showed ARDS. Consideration was given to starting steroids but they were not started. Following the arrival of the transport team, KB was intubated due to work of breathing, high oxygen requirement and tachycardia. Her pressure and oxygen requirement remained high and nitic was started. She was established on ventilator settings of 30/12 rate 23, nitric 20ppm and 50 percent oxygen. Despite high ventilator pressures CO2 remained high and she was started on HFOV. A large pleural effusion was drained. She was ventilated for a total of 4 days. She recovered well and was discharged. Initial lung function showed a restrictive defect which resolved. Results: CT chest. Widespread bilateral consolidation, pleural effusions. Deranged liver function and coagulopathy- PT 22.9 APTT 29 and fibrinogen 4.5. Gamma GT 300 CRP 300. Cultures and virology negative Conclusions: CDC case definition of confirmed case of vaping associated lung disease Vaping (within 90 days) AND pulmonary infiltrates AND absence of infection AND no plausible alternative diagnosis. KB would fit CDC criteria 2019 Vaping associated lung disease can cause respiratory failure in children.

Update on the Role of High-Flow Nasal Cannula in Infants with Bronchiolitis.

Bronchiolitis (BR), a lower respiratory tract infection mainly caused by respiratory syncytial virus (RSV), can be very severe. Presently, adequate nutritional support and oxygen therapy remain the only interventions recommended to treat patients with BR. For years, mild BR cases were treated with noninvasive standard oxygen therapy (SOT), i.e., with cold and poorly or totally non-humidified oxygen delivered by an ambient headbox or low-flow nasal cannula. Children with severe disease were intubated and treated with invasive mechanical ventilation (IMV). To improve SOT and overcome the disadvantages of IMV, new measures of noninvasive and more efficient oxygen administration have been studied. Bi-level positive air way pressure (BiPAP), continuous positive airway pressure (CPAP), and high-flow nasal cannula (HFNC) are among them. For its simplicity, good tolerability and safety, and the good results reported in clinical studies, HFNC has become increasingly popular and is now widely used. However, consistent guidelines for initiation and discontinuation of HFNC are lacking. In this narrative review, the role of HFNC to treat infants with BR is discussed. An analysis of the literature showed that, despite its widespread use, the role of HFNC in preventing respiratory failure in children with BR is not precisely defined. It is not established whether it can offer greater benefits compared to SOT and when and in which infants it can replace CPAP or BiPAP. The analysis of the results clearly indicates the need for multicenter studies and official guidelines. In the meantime, HFNC can be considered a safe and effective method to treat children with mild to moderate BR who do not respond to SOT.

Extracorporeal membrane oxygenation for respiratory failure in children: the years before and after the 2009 H1N1 pandemic.

Objective:To evaluate whether there was any impact on the number of pediatric extracorporeal membrane oxygenation runs and survival rates in the years subsequent to the 2009 pandemic.Methods:We studied two different periods of extracorporeal membrane oxygenation support for respiratory failure in children by analyzing datasets from the Extracorporeal Life Support Organization. Autoregressive integrated moving average models were constructed to estimate the effect of the pandemic. The year 2009 was the year of intervention (the H1N1 epidemic) in an interrupted time series model. Data collected from 2001 - 2010 were considered preintervention, and data collected from 2010 - 2017 were considered postintervention.Results:There was an increase in survival rates in the period 2010 - 2017 compared to 2001 - 2010 (p < 0.0001), with a significant improvement in survival when extracorporeal membrane oxygenation was performed for acute respiratory failure due to viral pneumonia. The autoregressive integrated moving average model shows an increase of 23 extracorporeal membrane oxygenation runs per year, prior to the point of the level effect (2009). In terms of survival, the preslope shows that there was no significant increase in survival rates before 2009 (p = 0.41), but the level effect was nearly significant after two years (p = 0.05), with a 6% increase in survival. In four years, there was an 8% (p = 0.03) increase in survival, and six years after 2009, there was up to a 10% (p = 0.026) increase in survival.Conclusion:In the years following 2009, there was a significant, global incremental increase in the extracorporeal membrane oxygenation survival rates for all runs, mainly due to improvements in the technology and treatment protocols for acute respiratory failure related to viral pneumonia and other respiratory conditions.

Acute viral bronchiolitis as a cause of pediatric acute respiratory distress syndrome

The Pediatric Acute Lung Injury Consensus Conference (PALICC) published pediatric-specific guidelines for the definition, management, and research in pediatric acute respiratory distress syndrome (PARDS). Acute viral bronchiolitis (AVB) remains one of the leading causes of admission to PICU. Respiratory syncytial virus (RSV) is the most common cause of AVB. We aimed to evaluate the incidence of PARDS in AVB and identify the risk of RSV as a trigger pathogen for PARDS. This study is a retrospective single-center observational cohort study including children < 2 years of age admitted to the pediatric intensive care unit at St Mary’s Hospital, London, and presented with AVB in 3 years (2016–2018). Clinical and demographic data was collected; PALICC criteria were applied to define PARDS. Data was expressed as median (IQR range); non-parametric tests were used. In this study, 144 infants with acute viral bronchiolitis were admitted to PICU in the study period. Thirty-nine infants fulfilled criteria of PARDS with RSV as the most common virus identified. Bacterial infection was identified as a risk factor for development of PARDS in infants with AVB.Conclusion: AVB is an important cause of PARDS in infants. RSV is associated with a higher risk of PARDS in AVB. Bacterial co-infection is a significant risk factor for development of PARDS in AVB.What is Known:• Bronchiolitis is a common cause of respiratory failure in children under 2 years.• ARDS is a common cause of PICU admission.What is New:• Evaluation of bronchiolitis as a cause of PARDS according to the PALLIC criteria.• Evaluation of different viruses’ outcome in PARDS especially RSV as a commonest cause of AVB.

Noninvasive Ventilation and Mechanical Insufflator-Exsufflator for Acute Respiratory Failure in Children With Neuromuscular Disorders.

Children with neuromuscular disorder (NMD) usually have pulmonary involvement characterized by weakened respiratory muscles, insufficient coughing, and inability to clear airway secretions. When suffering from community-acquired pneumonia, these patients are more likely to develop acute respiratory failure (ARF). Therefore, recurrent pneumonias leading to acute on chronic respiratory failure accounts for a common cause of mortality in children with NMD. For many years, noninvasive ventilation (NIV) has been regarded as a life-prolonging tool and has been used as the preferred intervention for treating chronic hypoventilation in patients with advanced NMD. However, an increasing number of studies have proposed the utility of NIV as first-line management for acute on chronic respiratory failure in NMD patients. The benefits of NIV support in acute settings include avoiding invasive mechanical ventilation, shorter intensive care unit or hospital stays, facilitation of extubation, and improved overall survival. As the difficulty in clearing respiratory secretions is considered a significant risk factor attributing to NIV failure, combined coughing assistance of mechanical insufflator-exsufflator (MI-E) with NIV has been recommended the treatment of acute neuromuscular respiratory failure. Several recent studies have demonstrated the feasibility and effectiveness of combined NIV and MI-E in treating ARF of children with NMD in acute care settings. However, to date, only one randomized controlled study has investigated the efficacy of NIV in childhood ARF, but subjects with underlying NMD were excluded. It reflects the need for more studies to elaborate evidence-based practice, especially the combined NIV and MI-E use in children with acute neuromuscular respiratory failure. In this article, we will review the feasibility, effectiveness, predictors of outcome, and perspectives of novel applications of combined NIV and MI-E in the treatment of ARF in NMD children.

CLINICAL AND PHYSIOLOGICAL JUSTIFICATION OF WEANING FROM MECHANICAL VENTILATION IN CHILDREN WITH RESPIRATORY FAILURE

Children frequently are admitted to pediatric intensive care units due to acute respiratory failure and up to 64 % of them need to be mechanically ventilated and later weaned. The aim was to develop strategy of weaning from mechanical ventilation in children with different types of respiratory failure. Materials and methods. The work was based on results of treatment of 237 patients aged from 1 month to 18 years old, who were divided into control and study group. Patients of study group were randomized into group I (83 patients) and received traditional ICU monitoring and treatment and group II (79 patients), where was used proposed by us methods of monitoring and treatment. Results. There was supplemented data on the etiology of respiratory failure in children with taking into account function of diaphragm, changes in hemodynamics, nutritional status, electrolyte balance and central nervous system function. It was established new mechanisms of inadequacy of spontaneous breathing during mechanical ventilation and found causes of unsuccessful weaning from mechanical ventilation. In addition, it was developed a weaning strategy with goal-directed therapy for disorders treatment according the type of respiratory failure and children`s age. As a result, important scientific problem was solved and the results of treatment of children with respiratory failure was improved. Conclusions. It was found that proposed strategy of weaning from mechanical ventilation allowed to reduce the duration of mechanical ventilation and the frequency of complications (reintubations). There were no significant differences in the frequency of tracheostomy among patients of I and II groups.

Respiratory failure in children with oncohematological and immunological diseases: methods of treatment

Acute respiratory distress syndrome (ARDS) against the background of a lung infection is one of the chief reasons for a fatal outcome in children with oncohematological and immunological diseases. This is due to the fact that in 16–24% of these patients, it is not possible to treat critical hypoxemia successfully using the traditional methods of mechanical ventilation (MV) of the lungs. For patients with ARDS, the method of choice for treating critical hypoxemia is extracorporeal membrane oxygenation (ECMO), but pronounced cytopenia, immunosuppression and hemostatic system disorders constitute absolute contraindications for ECMO, owing to a high risk of numerous fatal complications. Therefore, there remains currently a rather relevant problem: specifically, the search for alternative methods of mechanical ventilation, which would aim to improve oxygenation and gas exchange during severe forms of ARDS in children with oncohematological and immunological diseases. One of such methods is superimposed high-frequency jet ventilation (SHFJV).

Clinical features of severe respiratory failure in children at 37 weeks’ gestational age

Purpose is to determine the clinical features of severe respiratory failure in newborns whose gestational age was 37 weeks. Methods Design – it was a retrospective, controlled, non-randomized, single-center study. 40 patients satisfied the inclusion and exclusion criteria. 7 (1.1%) children died. Depending on their gestational age, patients were divided into two groups. The basic group (n= 279) included newborns whose gestational age was 37 weeks. Children born at 34–36 weeks of pregnancy were in the group of comparison (n= 361). Patients from the both groups underwent a comparable intensive treatment and had similar values of initial treatment of ALV such as respiratory volume of at least 6 ml/kg, PEEP of 4–6 cm H2O, PRVS mode. BioStat was used for statistical analysis. Results . The rate of episodes of severe respiratory failure is quite comparable between the basic group and the group of comparison. Non-invasive ALV was more frequently used by patients from the basic group (χ2=4.23; p=0.05). Fetal growth restriction and higher pressure in the pulmonary artery was an important feature of respiratory failure course in children whose gestational age was 37 weeks as it resulted in a significantly higher rate of pulmonary hemorrhage episodes (χ2=9.608; р=0.02). Respiratory issues typical of the children can be seen only in those born by Cesarean section. Conclusion . The features of severe respiratory failure at 37 weeks’ gestational age include the children’s development when Cesarean section is used, fetal growth restriction and higher pressure in the right ventricle with more frequent episodes of pulmonary bleeding.