Non-Invasive Ventilation in Acute Respiratory Failure in Children

Abstract

The aim of this paper is to assess the clinical efficacy of non-invasive ventilation (NIV) in avoiding endotracheal intubation (ETI), to demonstrate clinical and gasometric improvement and to identify predictive risk factors associated with NIV failure. An observational prospective clinical study was carried out. Included Patients with acute respiratory disease (ARD) treated with NIV, from November 2006 to January 2010 in a Pediatric Intensive Care Unit (PICU). NIV was used in 151 patients with acute respiratory failure (ARF). Patients were divided in two groups: NIV success and NIV failure, if ETI was required. Mean age was 7.2±20.3 months (median: 1 min: 0,3 max.: 156). Main diagnoses were bronchiolitis in 102 (67.5%), and pneumonia in 44 (29%) patients. There was a significant improvement in respiratory rate (RR), heart rate (HR), pH, and pCO2 at 2, 6, 12 and 24 hours after NIV onset (P<0.05) in both groups. Improvement in pulse oximetric saturation/fraction of inspired oxygen (SpO2/FiO2) was verified at 2, 4, 6, 12 and 24 hours after NIV onset in the success group (P<0.001). In the failure group, significant SpO2/FiO2 improvement was only observed in the first 4 hours. NIV failure occurred in 34 patients (22.5%). Risk factors for NIV failure were apnea, prematurity, pneumonia, and bacterial co-infection (P<0.05). Independent risk factors for NIV failure were apneia (P<0.001; odds ratio 15.8; 95% confidence interval: 3.42–71.4) and pneumonia (P<0.001, odds ratio 31.25; 95% confidence interval: 8.33–111.11). There were no major complications related with NIV. In conclusion this study demonstrates the efficacy of NIV as a form of respiratory support for children and infants with ARF, preventing clinical deterioration and avoiding ETI in most of the patients. Risk factors for failure were related with immaturity and severe infection.

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

“…Moreover, about 20% of our patients had variable degrees of ALI. The type of ARF did not significantly affect the outcome of the NIV trial in our study, though we had better improvement with type 1 and this was in agreement with Muñoz-Bonet et al [5], but in contradiction to the findings of Abadesso et al [11] and Essouri et al [12], who achieved lower success with type 1 ARF compared to type 2. Perhaps this disparity is due to the inability to quantify the severity of either type of ARF in any of the previous studies together with the wide variability of the cause of ARF rather than its type.…”

“…Perhaps this disparity is due to the inability to quantify the severity of either type of ARF in any of the previous studies together with the wide variability of the cause of ARF rather than its type. Most of our patients (54%) had pneumonia as a cause of ARF, which is higher than the observed diagnosis in other studies [5,10,11]. Yet, this percentage is a real reflection of the general high rate of pneumonia in Egyptian children compared to other countries [13].…”

“…Yet, this percentage is a real reflection of the general high rate of pneumonia in Egyptian children compared to other countries [13]. Interestingly, the success rate of NIV amongst patients with pneumonia in this study was 74%, which is comparable and even higher than other studies [11]. Though the use of NIV in ARDS/ALI is controversial in adults [14][15][16][17], trials with its application in some pediatric studies are evolving.…”

Non-invasive Ventilation in Children with Acute Respiratory Failure

“…18 İspanya'dan çocuk yoğun bakım ünitesinde apne ve pnömonili çocukların çoğunluğu oluştur-duğu bir başka pediatrik seride ise 149 hastanın %78'inde başarıyla uygulanabilmiştir. 19 Bizim ça-lışmamızda ise hastaların büyük çoğunluğunda altta yatan kronik hastalıkları olmasına rağmen başarı oranı %65,5 olarak saptanmıştır. Hasta sayımız az olmakla birlikte 10 hasta entübe edilmiş ve bu hastalardan ikisi kaybedilmiştir.…”

Dislodgement of Laparoscopic Gastrostomy During Early Postoperative Period: an unusual complication of non-invasive ventilation

“…NIV reduces the need for invasive mechanical ventilation (MV), the rate of reintubation, the risk of ventilator associated pneumonia, and the length of hospital stay. 2 Although NIV is well tolerated by most of the patients, various complications have been described. These complications ranges from patient discomfort to life-threatening conditions like aspiration pneumonia or hypotension.…”