Non-Invasive Ventilation in Children with Paediatric Acute Respiratory Distress Syndrome

Abstract

Introduction: Evidence supporting non-invasive ventilation (NIV) in paediatric acute respiratory distress syndrome (PARDS) remains sparse. We aimed to describe characteristics of patients with PARDS supported with NIV and risk factors for NIV failure. Materials and Methods: This is a multicentre retrospective study. Only patients supported on NIV with PARDS were included. Data on epidemiology and clinical outcomes were collected. Primary outcome was NIV failure which was defined as escalation to invasive mechanical ventilation within the first 7 days of PARDS. Patients in the NIV success and failure groups were compared. Results: There were 303 patients with PARDS; 53/303 (17.5%) patients were supported with NIV. The median age was 50.7 (interquartile range: 15.7-111.9) months. The Paediatric Logistic Organ Dysfunction score and oxygen saturation/fraction of inspired oxygen (SF) ratio were 2.0 (1.0-10.0) and 155.0 (119.4-187.3), respectively. Indications for NIV use were increased work of breathing (26/53 [49.1%]) and hypoxia (22/53 [41.5%]). Overall NIV failure rate was 77.4% (41/53). All patients with sepsis who developed PARDS experienced NIV failure. NIV failure was associated with an increased median paediatric intensive care unit stay (15.0 [9.5-26.5] vs 4.5 [3.0-6.8] days; P <0.001) and hospital length of stay (26.0 [17.0-39.0] days vs 10.5 [5.5-22.3] days; P = 0.004). Overall mortality rate was 32.1% (17/53). Conclusion: The use of NIV in children with PARDS was associated with high failure rate. As such, future studies should examine the optimal selection criteria for NIV use in these children. Key words: Bi-level positive airway pressure, Continuous positive airway pressure, Non-invasive ventilation

Noninvasive Ventilation for Pediatric Acute Respiratory Distress Syndrome: Experience From the 2016/2017 Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Prospective Cohort Study*

“…Severe hypoxemia has been consistently reported as a risk factor for NIV failure (10,11,13,23). The risk of NIV failure associated with nonpulmonary organ dysfunction is also consistent with previous studies that reported higher NIV failure rates in the presence of sepsis (10,12,23,24), vasoactive agents (25), or higher PRISM scores (10,12,23). Immunosuppression was associated with both NIV use and NIV failure in this study.…”

S2k-Leitlinie Nichtinvasive Beatmung als Therapie der akuten respiratorischen Insuffizienz

“…Die nichtinvasive Beatmung zu Behandlung der ARI hat ihren festen Stellenwert in der Behandlung von Säuglingen und Kinder auf der pädiatrischen Intensivstation. Die Evidenz zum Nutzen der NIV kommt u. a. aus kleineren randomisierten Studien 499 500 501 502 503 504 505 506 507 508 , Cross-over-Studien 509 510 511 512 , prospektiven 90 94 101 513 514 515 516 517 518 519 520 521 522 523 524 525 526 527 528 529 530 531 532 533 534 535 536 537 538 539 und retrospektiven Kohortenstudien 91 93 95 97 540 541 542 543 544 545 546 547 548 549 550 551 552 553 554 555 556 557 558 559 560 561 562 563 . Trotz der vielen Studien ist aufgrund der meist kleinen Fallzahlen und Heterogenität der untersuchten Kohorten eine Überlegenheit von NIV im Vergleich zu Standardtherapie für viele Indikationen im Kindesalter außerhalb der Neugeborenen Periode unzureichend belegt.…”

Noninvasive Respiratory Support for Pediatric Acute Respiratory Distress Syndrome: From the Second Pediatric Acute Lung Injury Consensus Conference

“…The literature search identified 6,336 studies, 187 were selected for full-text review, and 14 underwent data extraction (36–50) ( Supplemental Fig. S1 , http://links.lww.com/PCC/C300).…”

“…Evidence for the use of NIV in PARDS is based mostly on observational studies and two randomized controlled trials (RCTs) ( Table 1 ) (3–8, 10, 18, 28, 29, 36, 37, 43, 46, 48–50). Many of these studies include a heterogeneous pediatric population from at risk to severe PARDS.…”

“…However, delayed intubation and NIV failure may be harmful in children with PARDS. In two observational studies, children with NIV failure had longer duration of PICU LOS compared with those who were successfully treated with NIV (46, 50) and compared with historical controls (51). Timely prediction of NIV failure is therefore critical in children with PARDS.…”