ABSTRACT
Objective:
To describe the use of noninvasive ventilation to prevent tracheal intubation in children in a pediatric intensive care unit and to analyze the factors related to respiratory failure.
Methods:
A retrospective cohort study was performed from January 2016 to May 2018. The study population included children aged 1 to 14 years who were subjected to noninvasive ventilation as the first therapeutic choice for acute respiratory failure. Biological, clinical and managerial data were analyzed by applying a model with the variables that obtained significance ≤ 0.20 in a bivariate analysis. Logistic regression was performed using the ENTER method. The level of significance was set at 5%.
Results:
The children had a mean age of 68.7 ± 42.3 months, 96.6% had respiratory disease as a primary diagnosis, and 15.8% had comorbidities. Of the 209 patients, noninvasive ventilation was the first option for ventilatory support in 86.6% of the patients, and the fraction of inspired oxygen was ≥ 0.40 in 47% of the cases. The lethality rate was 1.4%. The data for the use of noninvasive ventilation showed a high success rate of 95.3% (84.32 - 106). The Pediatric Risk of Mortality (PRISM) score and the length of stay in the intensive care unit were the significant clinical variables for the success or failure of noninvasive ventilation.
Conclusion:
A high rate of effectiveness was found for the use of noninvasive ventilation for acute episodes of respiratory failure. A higher PRISM score on admission, comorbidities associated with respiratory symptoms and oxygen use ≥ 40% were independent factors related to noninvasive ventilation failure.
Keywords:
Noninvasive ventilation; Child; Intensive care units, pediatric; Respiratory insufficiency; Comorbidity; Ventilatory support
RESUMO
Objetivo:
Descrever o uso da ventilação não invasiva na prevenção da intubação traqueal em crianças em unidade de terapia intensiva pediátrica e analisar os fatores relacionados à falha.
Métodos:
Coorte retrospectiva referente ao período de janeiro 2016 a maio 2018. População composta por crianças entre1mês a14 anos, submetidas à ventilação não invasiva como primeira escolha terapêutica para insuficiência respiratória aguda. Analisaram-se os dados biológicos, clínicos e gerenciais, sendo aplicado um modelo com as variáveis que obtiveram significância ≤ 0,20 na análise bivariada. Foi realizada regressão logística pelo método de ENTER. Considerou-se nível de significância de 5%.
Resultados:
As crianças tiveram média de idade de 68,7 ± 42,3 meses, 96,6% tiveram como diagnóstico principal doença respiratória e 15,8% apresentavam comorbidades. Do total de 209, a ventilação não invasiva foi realizada como primeira opção de suporte ventilatório em 86,6% dos pacientes e a fração inspirada de oxigênio ≥ 0,40 em 47% dos casos. A letalidade foi de 1,4%. O gerenciamento dos dados do uso da ventilação não invasiva demonstrou alta taxa de sucesso, sendo esta de 95,3% (84,32 - 106). As variáveis clínicas significantes no sucesso ou na falha da ventilação não invasiva foram o Pediatric Risk of Mortality (PRISM) e o tempo de estadia na unidade de terapia intensiva.
Conclusão:
Observou-se alta taxa de efetividade no uso da ventilação não invasiva para episódios agudos de insuficiência respiratória. PRISM de admissão mais altos, comorbidades associadas ao quadro respiratório e uso de oxigênio ≥ 40%foram fatores independentes relacionados à falha da ventilação não invasiva.
Descritores:
Ventilação não invasiva; Criança; Unidades de terapia intensiva pediátrica; Insuficiência respiratória; Comorbidade; Suporte ventilatório
INTRODUCTION
Respiratory diseases are very common reasons for admissions in pediatric intensive care units (ICUs) in Brazil.(11 Lanetzki CS, Oliveira CA, Bass LM, Abramovici S, Troster EJ. O perfil epidemiológico do Centro de Terapia Intensiva Pediátrico do Hospital Israelita Albert Einstein. Einstein (São Paulo). 2012;10(1):16-21.,22 Batista NO, Coelho MC, Trugilho SM, Pinasco GC, Santos EF, Ramos-Silva V. Perfil clínico-epidemiológico de pacientes internados em unidade de cuidados intensivos pediátricos. Rev Bras Crescimento Desenvolv Hum. 2015;25(2):187-93.) Among such diseases, acute respiratory infections are among the major causes of morbidity and mortality in pediatric patients and are responsible for approximately 20 to 30% of deaths, especially in children under 5 years of age for whom the most frequent causes of death are pneumonia and bronchiolitis.(33 Racy NJ. Pneumonia é a maior responsável pelas hospitalizações de acordo com relatório do sistema do DATASUS. Diário Web.com.br. [Internet] 2014 [citado 2018 Dez 25]; Disponível em: http://datasus.saude.gov.br/noticias/atualizacoes/401-pneumonia-e-a-maior-responsavel-pelas-hospitalizacoes-de-acordo-com-relatorio-do-sistema-do-datasus.
http://datasus.saude.gov.br/noticias/atu...
,44 Ferlini R, Pinheiro FO, Andreolio C, Carvalho PR, Piva JP. Características e evolução de crianças com bronquiolite viral aguda submetidas à ventilação mecânica. Rev Bras Ter Intensiva. 2016;28(1):55-61.)
Among the critically ill pediatric patients hospitalized in ICUs, 30 to 50% require some type of mechanical ventilation support.(55 Farias JA, Frutos F, Esteban A, Flores JC, Retta A, Baltodano A, et al. What is the daily practice of mechanical ventilation in pediatric intensive care units? A multicenter study. Intensive Care Med. 2004;30(5):918-25.) Accordingly, immediate intervention for acute respiratory failure is needed, and mechanical ventilation is the most widely used therapeutic support modality. Currently, studies suggest that noninvasive ventilation (NIV) can be implemented as the first choice for ventilatory support in select cases to obviate invasive mechanical ventilation (IMV) via orotracheal intubation.(66 Mayordomo-Colunga J, Pons-Ódena M, Medina A, Rey C, Milesi C, Kallio M, et al. Non-invasive ventilation practices in children across Europe. PediatrPulmonol. 2018;53(8):1107-14.,77 Mortamet G, Emeriaud G, Jouvet P, Fauroux B, Essouri S. [Non-invasive ventilation in children: Do we need more evidence?] Arch Pediatr. 2017;24(1):58-65. French.)
Compared to IMV, NIV has advantages, such as a lower risk of pneumonia associated with mechanical ventilation, upper airway trauma and postextubation vocal cord dysfunction, maintenance of patient communication and feeding, and a reduced need for sedation, thus resulting in a lower risk of acquired muscle weakness and a shorter duration of mechanical ventilation.(88 Jalil Y, Damiani F, Astudillo C, Villarroel G, Barañao P, Bustos E, et al. Impact of a noninvasive ventilation protocol in hospitalized children with acute respiratory failure. Respir Care. 2017;62(12):1533-9.
9 Fedor KL. Noninvasive respiratory support in infants and children. Respir Care. 2017;62(6):699-717.-1010 Brochard L. Mechanical ventilation: invasive versus noninvasive. Eur Respir J Suppl. 2003;47:31S-7.)
NIV is being considered in many centers as an initial form of ventilatory support for acute respiratory failure in infants and children.(1111 Bernet V, Hug MI, Frey B. Predictive factors for the success of noninvasive mask ventilation in infants and children with acute respiratory failure. Pediatr Crit Care Med. 2005;6(6):660-4.
12 Crimi C, Noto A, Princi P, Esquinas A, Nava S. A European survey of noninvasive ventilation practices. Eur Respir J. 2010;36(2):362-9.-1313 Ducharme-Crevier L, Essouri S, Emeriaud G. Noninvasive ventilation in pediatric intensive care: from a promising to an established therapy, but for whom, when, why, and how? Pediatr Crit Care Med. 2015;16(5):481-2.)
Despite the increasing use of NIV, this therapy may not have the expected outcome in some conditions, and the need for intubation and the consequent use of invasive ventilation up to 72 hours after NIV suspension are defined as failure of NIV.(1414 Mosier JM, Sakles JC, Whitmore SP, Hypes CD, Hallett DK, Hawbaker KE, et al. Failed noninvasive positive-pressure ventilation is associated with an increased risk of intubation-related complications. Ann Intensive Care. 2015;5:4.,1515 Martín-González F, González-Robledo J, Sánchez-Hernández F, Moreno-García MN, Barreda-Mellado I. Effectiveness and predictors of failure of noninvasive mechanical ventilation in acute respiratory failure. Med Intensiva. 2016;40(1):9-17.) Patients selected for NIV as first-line treatment to avoid invasive ventilation should show marked improvement approximately 1 - 2 hours after the onset of ventilation, especially in oxygenation-related variables.(1616 Mayordomo-Colunga J, Pons M, López Y, José Solana M, Rey C, Martínez-Camblor P, et al. Predicting non-invasive ventilation failure in children from the SpO2/FiO2 (SF) ratio. Intensive Care Med. 2013;39(6):1095-103.,1717 Pediatric Acute Lung Injury Consensus Conference Group. Pediatric acute respiratory distress syndrome: consensus recommendations from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med. 2015;16(5):428-39.)
In 2017, the Pediatric Mechanical Ventilation Consensus Conference (PEMVECC) reported that the use of NIV has increased in acute respiratory infection cases, postcardiac surgery, status asthmaticus cases, and cases of neuromuscular disease exacerbations. In addition, to avoid delayed tracheal intubation, the success of NIV must be evaluated up to one hour after its initiation by observing the following parameters: heart rate, respiratory rate, the relationship between blood oxygen saturation and the fraction of inspired oxygen (SpO2/FiO2), pH, the level of consciousness and the presence of organ failure.(1818 Kneyber MC, de Luca D, Calderini E, Jarreau PH, Javouhey E, Lopez-Herce J, Hammer J, Macrae D, Markhorst DG, Medina A, Pons-Odena M, Racca F, Wolf G, Biban P, Brierley J, Rimensberger PC; section Respiratory Failure of the European Society for Paediatric and Neonatal Intensive Care. Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC). Intensive Care Med. 2017;43(12):1764-80.)
The objective of this study was to describe the use of NIV to prevent tracheal intubation in children in a pediatric ICU and to identify the independent factors related to NIV failure.
METHODS
A retrospective cohort observational study was conducted with information extracted from the management database of the pediatric ICU of the Hospital Esperança Recife (Rede D'Or, São Luiz) for the period from January 2016 to May 2018. This pediatric ICU includes ten beds available to clinical and surgical patients. The hospital is a reference hospital of medium and high complexity that has international standards accreditation (QmentumDiamante).
This study was approved by the Research Ethics Committee on Humans of the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) under number CAAE 90283018.4.0000.5201.
The population eligible for the study consisted of all children older than 1 month and up to 14 years and 11 months old receiving NIV as the first therapeutic choice for acute respiratory failure who were hospitalized in the unit during the analyzed period; the population was a convenience sample. Children receiving NIV at home due to chronic disease, those who received NIV only at the time of extubation, and those who arrived from the surgical block in the immediate postoperative period were excluded from the study.
After application of the eligibility criteria, biological and clinical data such as age, gender, weight, nutritional status and risk, the total number of admissions to the pediatric ICU, clinical diagnosis, the severity score at admission (Pediatric Risk of Mortality - PRISM II), the length of stay in the ICU, the total duration of NIV in days, success or failure of NIV, the mean duration, and the use rate of NIV, were collected. The variables related to the study were directly collected from data already recorded for quality management of the pediatric ICU and were recorded in a specific data sheet prepared for this study.
In the pediatric ICU, we have invasive ventilation ventilators microprocessed by NIV software and specific NIV apparatuses. Oronasal (facial) and nasal devices were used, and the choice of device was dependent on the condition and age of the child.
We considered NIV failure when a child required an artificial airway and conversion to IMV at some point during pediatric ICU hospitalization regardless of the duration of NIV.
Statistical analysis
Statistical Package for Social Science (SPSS) version 13.0 for Windows and Excel 2010 were used for the analysis. The results are shown in tables with their respective frequencies and measures of central tendency and dispersion. The Kolmogorov-Smirnov normality test was used for quantitative variables.
A comparison of biological and clinical variables between two groups (NIV success and failure) was performed using Student's t-test and the Mann-Whitney test.
To compose the model, the variables that obtained significance ≤ 0.20 in the bivariate analysis were included, and a subsequent logistic regression was performed using the ENTER method. A significance level of 5% was adopted.
RESULTS
Of the 888 children and adolescents admitted to the pediatric ICU during a period of 29 months (January 2016 to May 2018), 212 were subjected to NIV, although 3 patients were lost, resulting in 209 (23.5%) children and adolescents with NIV as the first therapeutic choice (Figure 1). Information regarding the three lost patients was not found in the managerial data and was therefore included in the sample loss related to the study.
Flowchart of participant selection according to the model suggested in the STROBE statement.(1919 Malta M, Cardoso LO, Bastos FI, Magnanini MM, Silva CM. Iniciativa STROBE: subsídios para a comunicação de estudos observacionais. Rev Saúde Pública.2010;44(3):559-65.)
The sample consisted of children with a median age of 65 months (interquartile range, 34 - 97), 58% were male, 96.6% had respiratory disease as a primary diagnosis, and 15.8% had associated comorbidities, such as cerebral palsy, genetic syndromes or some degree of delayed neuropsychomotor development. Among the 209 patients, NIV was performed as the first ventilatory support option within the first 24 hours of hospitalization in the pediatric ICU in 86.6% of the patients, and an FiO2 ≥ 0.40 was used in 47% of cases. The mortality rate was 1.4%. Data on the biological and clinical variables serving as the main reason for admission to the pediatric ICU, clinical severity scores, the mean duration of ICU hospitalization, the mean duration of NIV, the NIV success rate and ICU outcomes are shown in table 1.
Biological and clinical characteristics of 209 pediatric patients undergoing noninvasive ventilation
The data for NIV use, including the use rate and success rate, the duration of NIV, and the number of patients-day who used this type of ventilatory support, are shown in table 2.
Table 3 shows the comparison of clinical variables of children who experienced NIV success or failure. A significant difference was observed only in the PRISM II score.
According to the logistic regression analysis shown in table 4, the use of oxygen ≥ 40% and the presence of comorbidities were significant for NIV failure. In addition, the presence of comorbidities associated with the respiratory condition at admission increased the risk of NIV failure 14.59-fold.
Multivariate regression analysis of factors related to failure of noninvasive ventilation used in children as the first choice for ventilatory support
DISCUSSION
The use of NIV in clinical practice as the first option for ventilatory support to avoid endotracheal intubation and IMV has increased worldwide. In our study, we observed a high rate of NIV effectiveness as indicated by NIV success in 95.3 [84.32 - 106] children who received treatment for acute episodes of respiratory failure. This value may be explained by the early initiation of NIV in the pediatric ICU; 86.6% of the children started NIV within the first 24 hours after admission. The ICU provided 24-hour physical therapy with two professionals each morning, which enabled bedside assessments of the critically ill children.
Less expressive results were observed in a study conducted in a pediatric ICU in Turkey from 2012 to 2014,(2020 Yaman A, Kendirli, Ödek Ç, Ates C, Tasyapar N, Günes M, Ince E. Efficacy of noninvasive mechanical ventilation in prevention of intubation and reintubation in the pediatric intensive care unit. J Crit Care. 2016;32:175-81.) which evaluated 160 cases of NIV use for acute respiratory infection. Among these cases, NIV was used as the first support option in 89 cases, resulting in a 74.2% NIV success rate and a 25.8% NIV failure rate. The failure rate in the present study was only 6.2% (13 children among a total of 209).
In a 7-year retrospective study published in 2011, James et al.(2121 James CS, Hallewell CP, James DP, Wade A, Mok QQ. Predicting the success of non-invasive ventilation in preventing intubation and re-intubation in the paediatric intensive care unit. Intensive Care Med. 2011;37(12):1994-2001.) found an NIV success rate of 64% (53 of the 83 patients who used NIV as their first option), which was related to the prevention of intubation. The authors also reported that the oxygen support before starting NIV and its maintenance at high levels after 2 hours were higher in patients whose therapy failed, suggesting that higher levels of oxygen therapy can predict NIV failure. Similarly, regarding oxygen support, an FiO2 ≥ 40% was associated with a statistically significant increased risk for NIV failure.
According to our findings, the mean length of ICU stay among children who underwent NIV was 6.3 ± 8.7 days. Moreover, the group that achieved success showed a significant reduction in the length of stay in the ICU. In a study with adults, Pallin et al.(2222 Pallin M, Hew M, Naughton MT. Is non-invasive ventilation safe in acute severe asthma? Respirology.2015;20(2):251-7.) analyzed three groups (control, NIV and IMV), and the length of hospital stay in the NIV group was higher than that in the control group but lower than that in the group receiving invasive ventilation; however, the patients who underwent NIV represented a cohort with more severe acute diseases.
According to Izquierdo et al.,(2323 Izquierdo LM, Hernández K, Guzmán MC, de laHoz MC, Leon A, Rodríguez C. Predictores de éxito y fracasso en la utilización de ventilación mecánica no invasiva en pacientes de 2 unidades de cuidado intensivo pediátrico de la ciudad de Bogotá-Colombia. Acta Colomb Cuid Intensivo. 2017;17(2):85-154.) 70.2% of 252 patients experienced successful NIV. NIV failure predictors included a partial pressure of carbon dioxide (PaCO2) > 35mmHg, a partial pressure of oxygen (PaO2) < 60mmHg and a PRISM II score at admission > 10. In our research, blood gas data could not be analyzed; however, a relationship was found between the highest severity score (PRISM) and NIV failure. Similar data were also found in 2015 and 2016 by Bakalli et al.(2424 Bakalli I, Celaj E, Simaku A, Kola E, Sallabanda S. Predictors of noninvasive ventilation success in children with acute respiratory failure. Intensive Care Med. 2015;41(5):950-1.,2525 Bakalli I, Celaj E, Kola E, Sallabanda S, Simaku A. Time for noninvasive ventilation in children with acute respiratory failure. Pediatr Pol. 2016;91(5):430-5.) who reported that a PRISM score below 10 points may predict a lower risk of NIV failure. Yaman et al.(2020 Yaman A, Kendirli, Ödek Ç, Ates C, Tasyapar N, Günes M, Ince E. Efficacy of noninvasive mechanical ventilation in prevention of intubation and reintubation in the pediatric intensive care unit. J Crit Care. 2016;32:175-81.) also found that the highest PRISM II score is an independent variable that can predict the risk of NIV failure.
The rate of NIV use as the first choice of ventilatory support in acute respiratory infection cases was 23.2 [20 - 26, 32], suggesting that in the pediatric ICU, NIV is most often performed preventively to avoid the use of invasive ventilation. No publications on the rate of NIV use were found in the pediatric literature.
The mean NIV duration was 3.5 days. Yaman et al.(2020 Yaman A, Kendirli, Ödek Ç, Ates C, Tasyapar N, Günes M, Ince E. Efficacy of noninvasive mechanical ventilation in prevention of intubation and reintubation in the pediatric intensive care unit. J Crit Care. 2016;32:175-81.) found a median NIV duration of 48 hours in the studied groups.
In a study conducted in pediatric ICUs in the United Kingdom and Ireland, Morris et al.(2626 Morris JV, Ramnarayan P, Parslow RC, Fleming SJ. Outcomes for children receiving noninvasive ventilation as the first-line mode of mechanical ventilation at intensive care admission: a propensity score-matched cohort study. Crit Care Med. 2017;45(6):1045-53.) concluded that NIV use compared with IMV use as a first-line therapy was associated with significant decreases in mortality, the length of stay in the ICU and the NIV duration. They also observed that the first-line NIV use rate was 23.2 ± 2.3% among the total number of children admitted to the unit, and the NIV failure rate was 25.7%. Our results show that the mean length of stay in the pediatric ICU was shorter for patients who experienced NIV success (4.81 ± 5.06 days) than that for patients who had NIV failure (28.08 ± 29.00 days). Our rate of failure of NIV as the first treatment option was only 6.2%.
When NIV fails, the patient should be addressed promptly. Mortality is higher in patients who transition from NIV to IMV, and a late indication to transition from NIV to IMV may contribute to this outcome.(2323 Izquierdo LM, Hernández K, Guzmán MC, de laHoz MC, Leon A, Rodríguez C. Predictores de éxito y fracasso en la utilización de ventilación mecánica no invasiva en pacientes de 2 unidades de cuidado intensivo pediátrico de la ciudad de Bogotá-Colombia. Acta Colomb Cuid Intensivo. 2017;17(2):85-154.
24 Bakalli I, Celaj E, Simaku A, Kola E, Sallabanda S. Predictors of noninvasive ventilation success in children with acute respiratory failure. Intensive Care Med. 2015;41(5):950-1.
25 Bakalli I, Celaj E, Kola E, Sallabanda S, Simaku A. Time for noninvasive ventilation in children with acute respiratory failure. Pediatr Pol. 2016;91(5):430-5.
26 Morris JV, Ramnarayan P, Parslow RC, Fleming SJ. Outcomes for children receiving noninvasive ventilation as the first-line mode of mechanical ventilation at intensive care admission: a propensity score-matched cohort study. Crit Care Med. 2017;45(6):1045-53.-2727 Ozyilmaz E, Ugurlu AO, Nava S. Timing of noninvasive ventilation failure: causes, risk factors, and potential remedies. BMC Pulm Med.2014;14:19.) While the failure rate (6.2%) found in this study was low, three deaths were also noted - two of which occurred in the group with NIV failure. Similar data were found by Yaman et al.,(2020 Yaman A, Kendirli, Ödek Ç, Ates C, Tasyapar N, Günes M, Ince E. Efficacy of noninvasive mechanical ventilation in prevention of intubation and reintubation in the pediatric intensive care unit. J Crit Care. 2016;32:175-81.) with 7 deaths in the group with NIV failure and 1 death in the group with NIV success.
NIV failure can be categorized.(2727 Ozyilmaz E, Ugurlu AO, Nava S. Timing of noninvasive ventilation failure: causes, risk factors, and potential remedies. BMC Pulm Med.2014;14:19.) Of the 13 cases of failure in this study, 7 (53.8%) can be categorized as intermediate failure, and 6 (46.2%) can be categorized as late failure. Yaman et al.(2020 Yaman A, Kendirli, Ödek Ç, Ates C, Tasyapar N, Günes M, Ince E. Efficacy of noninvasive mechanical ventilation in prevention of intubation and reintubation in the pediatric intensive care unit. J Crit Care. 2016;32:175-81.) found 8 children with failure between 2 and 6 hours of NIV, 18 children with failure between 6 and 24 hours of NIV, and 22 children with failure after 24 hours of NIV.
The current study found that the presence of comorbidities (mostly neurological disorders) associated with respiratory symptoms on admission increases the risk of NIV failure. Corroborating these results, Morris et al.(2626 Morris JV, Ramnarayan P, Parslow RC, Fleming SJ. Outcomes for children receiving noninvasive ventilation as the first-line mode of mechanical ventilation at intensive care admission: a propensity score-matched cohort study. Crit Care Med. 2017;45(6):1045-53.) compared two groups receiving invasive and noninvasive ventilation and showed that the patients in the IMV group frequently had cardiovascular or neurological diagnoses, greater disease severity on admission and a worse outcome. Yaman et al.(2020 Yaman A, Kendirli, Ödek Ç, Ates C, Tasyapar N, Günes M, Ince E. Efficacy of noninvasive mechanical ventilation in prevention of intubation and reintubation in the pediatric intensive care unit. J Crit Care. 2016;32:175-81.) showed that 93.8% of patients with NIV failure had underlying diseases.
Precise assessment of malnutrition and the provision of adequate nutritional support remain major challenges in patients admitted to ICUs, especially critically ill patients. In our study, we used two criteria for nutritional assessment-nutritional status and risk-using the Screening Tool Risk Nutritional Status and Growth (STRONGkids). As our sample consisted of 72.2% eutrophic children, no relationship or association was found between nutritional status and risk and the NIV outcome.
In a prospective study published in 2018 with adult patients, Dangers et al. found an association between dyspnea and NIV failure, specifically, the presence of dyspnea after the first session of NIV and not upon admission to the ICU, suggesting that dyspnea may be a marker to assess the response to NIV.(2828 Dangers L, Montlahuc C, Kouatchet A, Jaber S, Meziani F, Perbet S, Similowski T, Resche-Rigon M, Azoulay E, Demoule A; REVA Network (Research Network in Mechanical Ventilation) and the Groupe de Recherche en Réanimation Respiratoire en Onco-Hématologie (GrrrOH); List of contributors who included study patients: Angers University Hospital, Angers, France. Dyspnea in patients receiving noninvasive ventilation for acute respiratory failure: prevalence, risk factors and prognostic impact: a prospective observational study. Eur Respir J. 2018;52(2). pii 1702637.) Our retrospective study was limited by the lack of clinical variables such as dyspnea, vital signs, and laboratory test results.
In 2017, the PEMVECC reported that to avoid delayed tracheal intubation, NIV success must be evaluated up to 1 hour after its initiation by observing the following parameters: heart rate, respiratory rate, SpO2/FiO2, pH, the level of consciousness and the presence of organ failure.(1818 Kneyber MC, de Luca D, Calderini E, Jarreau PH, Javouhey E, Lopez-Herce J, Hammer J, Macrae D, Markhorst DG, Medina A, Pons-Odena M, Racca F, Wolf G, Biban P, Brierley J, Rimensberger PC; section Respiratory Failure of the European Society for Paediatric and Neonatal Intensive Care. Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC). Intensive Care Med. 2017;43(12):1764-80.)
Limitations existed in our study, such as the retrospective design and the limited number of variables that may be related to the outcome, such as blood gas data and the initial ventilatory parameters. A strength of this study was our demonstration of the high effectiveness of NIV in children with respiratory failure. Over time, this practice has been strengthened in pediatric ICUs most likely due to greater clarification and training of a multidisciplinary team.
CONCLUSION
A high success rate was observed with the use of noninvasive ventilation in the children with respiratory failure analyzed; those with a higher PRISM score at admission, comorbidities associated with the respiratory condition and using oxygen ≥ 40% have a higher risk of noninvasive ventilation failure.
REFERÊNCIAS
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1Lanetzki CS, Oliveira CA, Bass LM, Abramovici S, Troster EJ. O perfil epidemiológico do Centro de Terapia Intensiva Pediátrico do Hospital Israelita Albert Einstein. Einstein (São Paulo). 2012;10(1):16-21.
-
2Batista NO, Coelho MC, Trugilho SM, Pinasco GC, Santos EF, Ramos-Silva V. Perfil clínico-epidemiológico de pacientes internados em unidade de cuidados intensivos pediátricos. Rev Bras Crescimento Desenvolv Hum. 2015;25(2):187-93.
-
3Racy NJ. Pneumonia é a maior responsável pelas hospitalizações de acordo com relatório do sistema do DATASUS. Diário Web.com.br. [Internet] 2014 [citado 2018 Dez 25]; Disponível em: http://datasus.saude.gov.br/noticias/atualizacoes/401-pneumonia-e-a-maior-responsavel-pelas-hospitalizacoes-de-acordo-com-relatorio-do-sistema-do-datasus
» http://datasus.saude.gov.br/noticias/atualizacoes/401-pneumonia-e-a-maior-responsavel-pelas-hospitalizacoes-de-acordo-com-relatorio-do-sistema-do-datasus -
4Ferlini R, Pinheiro FO, Andreolio C, Carvalho PR, Piva JP. Características e evolução de crianças com bronquiolite viral aguda submetidas à ventilação mecânica. Rev Bras Ter Intensiva. 2016;28(1):55-61.
-
5Farias JA, Frutos F, Esteban A, Flores JC, Retta A, Baltodano A, et al. What is the daily practice of mechanical ventilation in pediatric intensive care units? A multicenter study. Intensive Care Med. 2004;30(5):918-25.
-
6Mayordomo-Colunga J, Pons-Ódena M, Medina A, Rey C, Milesi C, Kallio M, et al. Non-invasive ventilation practices in children across Europe. PediatrPulmonol. 2018;53(8):1107-14.
-
7Mortamet G, Emeriaud G, Jouvet P, Fauroux B, Essouri S. [Non-invasive ventilation in children: Do we need more evidence?] Arch Pediatr. 2017;24(1):58-65. French.
-
8Jalil Y, Damiani F, Astudillo C, Villarroel G, Barañao P, Bustos E, et al. Impact of a noninvasive ventilation protocol in hospitalized children with acute respiratory failure. Respir Care. 2017;62(12):1533-9.
-
9Fedor KL. Noninvasive respiratory support in infants and children. Respir Care. 2017;62(6):699-717.
-
10Brochard L. Mechanical ventilation: invasive versus noninvasive. Eur Respir J Suppl. 2003;47:31S-7.
-
11Bernet V, Hug MI, Frey B. Predictive factors for the success of noninvasive mask ventilation in infants and children with acute respiratory failure. Pediatr Crit Care Med. 2005;6(6):660-4.
-
12Crimi C, Noto A, Princi P, Esquinas A, Nava S. A European survey of noninvasive ventilation practices. Eur Respir J. 2010;36(2):362-9.
-
13Ducharme-Crevier L, Essouri S, Emeriaud G. Noninvasive ventilation in pediatric intensive care: from a promising to an established therapy, but for whom, when, why, and how? Pediatr Crit Care Med. 2015;16(5):481-2.
-
14Mosier JM, Sakles JC, Whitmore SP, Hypes CD, Hallett DK, Hawbaker KE, et al. Failed noninvasive positive-pressure ventilation is associated with an increased risk of intubation-related complications. Ann Intensive Care. 2015;5:4.
-
15Martín-González F, González-Robledo J, Sánchez-Hernández F, Moreno-García MN, Barreda-Mellado I. Effectiveness and predictors of failure of noninvasive mechanical ventilation in acute respiratory failure. Med Intensiva. 2016;40(1):9-17.
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Publication Dates
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Publication in this collection
14 Oct 2019 -
Date of issue
Jul-Sep 2019
History
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Received
17 Sept 2018 -
Accepted
08 Apr 2019