Background and Aims Noninvasive ventilation (NIV) constitutes an alternative treatment for pediatric acute respiratory failure. However, tracheal intubation should not be delayed when considered necessary. Our main objective is to identify success/failure prognostic signs of NIV and determination of NIV characteristics.
Methods Noncontrolled, observational study in a PICU in a university hospital. All cases of NIV from June 2010 and March 2012 were included. Failure of NIV was defined as the requirement of endotracheal intubation at any time. The major characteristics of patients who were intubated were compared with the characteristics of those who were not after a trial of NIV. Predictive factors for failure of NIV were analysed by multivariate analysis.
Results 126 cases were included (60.3% males),mean age 25.3±40.5 months and mean weight 11±13 kg. There was 57.9% of type II respiratory failure. Bronchiolitis was the most frequent condition (28%), followed by upper airway obstruction (15.2%), acute cardiogenic pulmonary edema (15.2%) and pneumonia (14.4%). CPAP was the respiratory mode more used.NIV success rate was 67.5%: 2.3% in the first hour, 32% between 1st–12th hour and 23.3% between 12th–24th hour. Failure rate was greater among patients with type I respiratory failure (34.9%) and acute respiratory distress syndrome (66.7%). A lower heart and respiratory rate at 6 hours were associated with NIV failure (p<0.05).
Conclusions NIV is a useful and increasingly used ventilatory mode in PICU. Type I respiratory failure, decrease in heart rate and respiratory rate at 6 hours were risk factors for NIV failure. More studies involving predictive factors in children are still needed.