Non-invasive ventilation in acute respiratory failure Background: Non-invasive ventilation (NIV) has become a therapeutic tool for acute respiratory failure in pediatric patients. Objective: To describe NIV experience at a Pediatric Intensive Care Unit, identifying factors associated to modality failure. Methods: Patients cohort who received NIV in acute respiratory failure during 2005-2007. Recolection of clinical and gasometrical variables previous and subsequent to connection to NIV. Descriptive statistic and logistic regression analysis were performed. Results: 51 events of NIV, where 55% cases were congenital cardiopathies. NIV main indication was respiratory distress post-extubation (31.4%). 15 patients (29.4%) required CMV. In univariate logistic regression for variables, an independent association was found between FiO2 pre-connection and FiO2 subsequent to NIV connection, with necessity of CMV. 9% presented complications and mortality was not related to ventilatory modality. Conclusions: NIV is useful in pediatric patients with acute respiratory insufficiency, with low risk of complications. The variables associated with failure are easy to obtain and interpretate.
ResumenObjetivos'. evaluar la utilidad de la venHacion de alta frecuencia oscilatoria en el sindrome de dificultad respiraloria ccuca pedialrico. Padentes y metodo: once ninos de 3 dias a 8 afios (media 22,1 meses) con dano puirnonar difuso, en tratamiento con venti ; acion mecanica convencional e indice de oxigenacion mayor a 20 (42 ± 1 2,2} fueron sometidos en forma prospective no controlaca a ventilacion de alta frecuencia oscilatoria con volumen pulmonar elevado. Resuitados'. el indice de oxigenacion disrrvnuyo significativamente a 22 ± 9,6 en las primeras 4 h con ventilacion de clta frecuencia. Posteriormente la disminucion fue sostenida aunque no significative. Ocho pacientes sobrevivieron y fue>'on extubados desde ventilacion mecdnica convencional. De los tres Tallecidos, dos mostraron buena respuesta a la ventilacion de clta frecuencia, y ningunc de las muertes se relacion6 directamente con la folia respiratoria. La letalidod de estos pacientes, estirnada originalmente en mas de dos tercios, se redujo a menos de un tercio, como en otras series pediatricas de ventilacion con olta frecuencia osciiatoria. No se registraron complicaciones atribuibles cl procedirnier-.to. Conclusiones: la venfilacion oscilatoria de alta frecuencia parece una opcion eficaz y segura en ninos con dano pulironar agudo de diferentes causas, [Palabras clave: sindrome de dificutrad respiratoria adulto, respiracion artificial, ventilacion mecanica, alia frecuencia, osciiatoria.I 1. Unidad de Cuidados Intensivos, Servicio de Pediatrfa, te. Su propdsitO es disminuir el dano pulmonar HospitalcimicoPontificiaUniversidadCat61icadeChile. inducido por el volumen en la asistencia ventila-
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