Outcomes for Children Receiving Noninvasive Ventilation as the First-Line Mode of Mechanical Ventilation at Intensive Care Admission: A Propensity Score-Matched Cohort Study*

Abstract

1045Objectives: To compare outcomes of children receiving noninvasive ventilation with those receiving invasive ventilation as first-line mode of mechanical ventilation following unplanned intensive care admission. Design: Propensity score-matched cohort study analyzing data prospectively collected by the Pediatric Intensive Care Audit Network over 8 years (2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014). Setting: Thirty-one PICUs in the United Kingdom and Ireland; twenty-one of whom submitted Pediatric Critical Care Minimum Dataset data for the entire study period. Patients: Children consecutively admitted to study PICUs. Planned admissions following surgery, unplanned admissions from other hospitals, those on chronic ventilation, and those who did not receive mechanical ventilation on the day of PICU admission were excluded. Interventions: Use of noninvasive ventilation, rather than invasive ventilation, as the first-line mode of mechanical ventilation. Measurements and Main Results: PICU mortality, length of ventilation, length of PICU stay, and ventilator-free days at day 28. During the study period, there were 151,128 PICU admissions. A total of 15,144 admissions (10%) were eligible for analysis once predefined

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

“…NIV modalities have been shown to prevent intubation and reintubation in the adult and neonatal population[ 4 , 5 ]. Relatively few studies have assessed its efficacy in the pediatric critical care setting[ 6 - 10 ]. NIMV in particular is infrequently used outside of the neonatal intensive care unit (NICU) and, to our knowledge, has not been studied in the setting of acute respiratory failure in the PICU.…”

Non‐invasive ventilation practices in children across Europe

“…However, randomizing children with different pathologies to receive NIV or not would now raise ethical questions . A recent propensity score‐matched cohort study has suggested significant clinical benefits of NIV use, avoiding the conflicts of a RCT …”

“…4 A recent propensity scorematched cohort study has suggested significant clinical benefits of NIV use, avoiding the conflicts of a RCT. 5 It should be highlighted that the use of NIV in ARDS was quite frequent in moderate cases and even some participants applied NIV in 19 Thus, NIV use should be considered in the less severe patients, and always managed with particular caution. Some studies have suggested that an improvement should be noted within the first 1-2 h of NIV initiation in terms of oxygenation, either arterial oxygen partial pressure to fractional inspired oxygen ratio or pulse oximetry saturation to fractional inspired oxygen ratio.…”

“…NIV is currently the preferred strategy to treat many patients in acute respiratory failure (ARF), both in adults and children . Despite the paucity of randomized controlled trials (RCT) about its efficacy as a first‐line mode of mechanical ventilation in children, clinical evidence of the usefulness of NIV has led to a wide acceptance to treat several pathologies . Consequently, it has been reported that the use of NIV has significantly increased during the past two decades .…”

How, in what contexts, and why do quality dashboards lead to improvements in care quality in acute hospitals? Protocol for a realist feasibility evaluation

“…For PICANet, we selected use of non-invasive ventilation first for patients requiring ventilation, which has been shown to be associated with reduced mortality 55. However, this was not raised as an area of concern in our interviews with PICU clinicians.…”