Objective Identification of predictive factors for non-invasive ventilation (NIV) failure in pediatric patients.
Methods Prospective observational study performed in a Pediatric Intensive Care Unit (PICU) in a University Hospital. Eighty-seven patients who received NIV were included. Clinical data collected were respiratory rate (RR), heart rate (HR) and FiO2 before NIV began. The same data and inspiratory (IP) and expiratory (EP) pressures were collected at 1, 6, 12, 24 and 48 hours. Conditions precipitating respiratory failure were classified into two groups: type 1 ARF (hypoxemic) − 29 episodes; and type 2 ARF (hypercapnic) − 58 episodes. Factors predicting NIV failure were determined by multivariate analysis.
Results NIV success rate was 86.2% (72.4% in type 1 and 93.1% in type 2). Type 1 ARF patients showed a higher risk of NIV failure compared to type 2 ARF (OR 16.988; 95% CI 2.895 to 99.669). A lower RR before starting NIV (OR 0.929; 95% CI 0.869 to 0.994), and a lower RR decrease (at 1 hour and at 6 hours; OR 0.907; 95% CI 0.832 to 0.989 and OR 0.895; 95% CI 0.895 to 0.992, respectively) were also independently associated with NIV failure.
Conclusions NIV has a high success rate in pediatric patients. Type 1 group classification, lower RR before starting NIV, and lower RR decrease during NIV were independent risk factors for NIV failure.