Clinical characteristics and outcomes associated with nasal intermittent mandatory ventilation in acute pediatric respiratory failure

Wang, Billy C; Pei, Theodore; Lin, Cheryl; Guo, Rong; Elashoff, David; Lin, James A.; Pineda, Carol

doi:10.5492/wjccm.v7.i4.46

Cited by 6 publications

(6 citation statements)

References 18 publications

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“…Indeed, there was a lower rate of multiple HFNC episodes post‐protocol. In previous studies, the average length of time on HFNC therapy ranged from 3.8 to 3.9 days and LOS ranges from 6 to 8 days 26–28 . Our study showed a post‐protocol median length of time on HFNC therapy of 2.04 days and LOS of 5.97 days.…”

Section: Discussionsupporting

confidence: 52%

A pediatric high‐flow nasal cannula protocol standardizes initial flow and expedites weaning

Wiser

Smith

Khallouq

et al. 2021

Pediatric Pulmonology

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Objective Respiratory illnesses compose the most common diagnoses of patients admitted to pediatric intensive care units. In pediatrics, high‐flow nasal cannula (HFNC) therapy is an intermediate level of respiratory support with variability in practice. We conducted a pre‐post intervention study of patients placed on HFNC therapy before and after the implementation of an HFNC protocol. Methods This was a quality improvement/pre‐post intervention study of pediatric patients who received HFNC therapy in our teaching, tertiary care children's hospital between January 2015 and April 2019. Patients were evaluated before and after the implementation of a protocol that promoted initiation of higher flow and rapid weaning. Our primary outcomes were initial flow and rate of weaning pre‐ and post‐protocol; our secondary outcomes were HFNC failure rate (defined as escalation to noninvasive ventilation or mechanical ventilation) and length of hospital stay. Propensity matching was used to account for differences in age and weight pre‐ and post‐protocol. Results In total, 584 patients were included, 292 pre‐protocol, and 292 post‐protocol. The median age was 20 months, and the indication for HFNC therapy was bronchiolitis in 29% of patients. Post‐protocol patients compared to pre‐protocol patients had significantly a higher initial flow (median 14.5 L/min vs. 10 L/min, p < .001) and a higher weaning rate of flow (median 4.1 L/min/h vs. 2.4 L/min/h, p < .001). Post‐protocol patients also had a lower HFNC failure rate (10% vs. 17%, p = .015) and a shorter length of stay (5.97 days vs. 6.80 days, p = .006). Conclusion Among pediatric patients, the implementation of an HFNC protocol increases initial flow, allows for more rapid weaning, and may decrease the incidence of escalation to noninvasive ventilation or mechanical ventilation.

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Section: Discussionsupporting

confidence: 52%

A pediatric high‐flow nasal cannula protocol standardizes initial flow and expedites weaning

Wiser

Smith

Khallouq

et al. 2021

Pediatric Pulmonology

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“…Continuous positive airway pressure (CPAP) has shown its effectiveness to reduce the work of breathing (WOB) in infants with acute bronchiolitis 5,6 and is nowadays largely recommended as a first line treatment of bronchiolitis respiratory failure 4–7 . Noninvasive positive pressure ventilation (NIPPV), by delivering an additional positive pressure during inspiration with the aim to reduce the patient's respiratory effort to a greater extent than CPAP, 8 is increasingly used in case of CPAP failure and has been shown to be associated with a reduced need of invasive ventilation in case of hypoxic respiratory failure 9–12 . However, its effectiveness may be limited because of patient–ventilator asynchrony (PVA).…”

Section: Introductionmentioning

confidence: 99%

Respiratory effort during noninvasive positive pressure ventilation and continuous positive airway pressure in severe acute viral bronchiolitis

Vedrenne-Cloquet

Khirani

Griffon

et al. 2023

Pediatric Pulmonology

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Objectives: To assess if noninvasive positive pressure ventilation (NIPPV) is associated with a greater reduction in respiratory effort as compared to continuous positive airway pressure (CPAP) during severe acute bronchiolitis, with both supports set either clinically or physiologically.Methods: Twenty infants (median [IQR] age 1.2 [0.9; 3.2] months) treated <24 h with noninvasive respiratory support (CPAP Clin, set at 7 cmH 2 O, or NIPPV Clin) for bronchiolitis were included in a prospective single-center crossover study. Esogastric pressures were measured first with the baseline support, then with the other support. For each support, recordings were performed with the clinical setting and a physiological setting (CPAP Phys and NIPPV Phys), aiming at normalising respiratory effort. Patients were then treated with the optimal support. The primary outcome was the greatest reduction in esophageal pressure-time product (PTP ES /min). Other outcomes included improvement of the other components of the respiratory effort.Results: NIPPV Clin and Phys were associated with a lower PTP ES /min (164 [105; 202] and 106 [78; 161] cmH 2 O s/min, respectively) than CPAP Clin (178 [145; 236] cmH 2 O s/min; p = 0.01 and 2 × 10 −4 , respectively). NIPPV Clin and Phys were also associated with a significant reduction of all other markers of respiratory effort as compared to CPAP Clin. PTP ES /min with NIPPV (Clin or Phys) was not different from PTP ES /min with CPAP Phys. There was no significant difference between physiological and clinical settings. Conclusion:NIPPV is associated with a significant reduction in respiratory effort as compared to CPAP set at +7 cmH 2 O in infants with severe acute bronchiolitis. CPAP Phys performs as well as NIPPV Clin.

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“…Noninvasive positive pressure ventilation (NIPPV) techniques include continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BIPAP). They are used in various etiologies [11][12][13] and the decision of modality depends on the nature of respiratory failure: CPAP for hypoxic ARF and smaller children, BIPAP for older children with hypoxic and / or hypercapnic ARF [14]. Although not classified as positive pressure ventilation, high flow humidified nasal cannula ventilation (HFNC) is gaining interest in pediatric practice and is presented as an alternative to CPAP in infants.…”

Section: Introductionmentioning

confidence: 99%

A multicentered study on efficiency of noninvasive ventilation procedures (SAFE-NIV)

et al. 2021

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Background/aim: To characterize the clinical course of noninvasive positive pressure ventilation (NIPPV) and high flow humidified nasal cannula ventilation (HFNC) procedures; perform risk analysis for ventilation failure. Material and methods: This prospective, multi-centered, observational study was conducted in 352 PICU admissions (1 month-18 years) between 2016 and 2017. SPSS-22 was used to assess clinical data, define thresholds for ventilation parameters and perform risk analysis. Results: Patient age, onset of disease, previous intubation and hypoxia influenced the choice of therapy mode: NIPPV was preferred in older children (p = 0.002) with longer intubation (p < 0.001), ARDS (p = 0.001), lower respiratory tract infections (p < 0.001), chronic respiratory disease, (p = 0.005), malignancy (p = 0.048) and immune deficiency (p = 0.026).The failure rate was 13.4%. Sepsis, ARDS, prolonged intubation and use of nasal masks were associated with NIV failure (p = 0.001, p < 0.001, p < 0.001, p = 0.025). The call of intubation or re-intubation was given due to respiratory failure in twenty-seven (57.5%), hemodynamic instability in eight (17%), bulbar dysfunction or aspiration in five (10.6%), neurological deterioration in four (8.5%) and developing ARDS in three (6.4%) children. A reduction of less than 10% in the respiration within an hour increased the odds of failure by 9.841 times (OR:9.841, 95% CI: 2.0021-48.3742). FiO 2 >55% at 6 th hours and PRISM-3 >8 were other failure predictors. Of the 9.9% complication rate, the most common complication was pressure ulcerations (4.8%) and mainly observed when using full-face masks (p = 0.047). Fifteen (4.3%) patients died of miscellaneous causes. Tracheostomy cannulation was performed on sixteen children due to prolonged mechanical ventilation (8% in NIPPV, 2.6% in HFNC) Conclusion: Absence of reduction in the respiration rate within an hour, FiO 2 requirement >55% at 6 th hours and PRISM-3 score >8 predict NIV failure.

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Clinical characteristics and outcomes associated with nasal intermittent mandatory ventilation in acute pediatric respiratory failure

Cited by 6 publications

References 18 publications

A pediatric high‐flow nasal cannula protocol standardizes initial flow and expedites weaning

A pediatric high‐flow nasal cannula protocol standardizes initial flow and expedites weaning

Respiratory effort during noninvasive positive pressure ventilation and continuous positive airway pressure in severe acute viral bronchiolitis

A multicentered study on efficiency of noninvasive ventilation procedures (SAFE-NIV)

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