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Predicting non-invasive ventilation failure in children from the SpO2/FiO2 (SF) ratio

Juan Mayordomo-Colunga| Martí Pons| Yolanda López| M. José Solana| Corsino Rey| Pablo Martínez-Camblor| Antonio Rodríguez-Núñez| Jesús López-Herce| Alberto Medina| Clara Abadesso| M. Ángeles García-Teresa| Mirella Gáboli| Milagros García-López| María González-Sánchez| Paula Madurga-Revilla| Amelia González-Calvar| Eider Oñate
Pediatric Original
Volume 39, Issue 6 / June , 2013

Pages 1095 - 1103

Abstract

Purpose

Our objective was to assess whether SpO2/FiO2 (SF) ratio could be a useful NIV outcome predictor in children with acute respiratory failure (ARF) and tried to develop a predictive model of NIV failure.

Methods

Prospective, observational, multicenter study. Episodes of ARF-fulfilling inclusion criteria from 15 January 2010 to 14 January 2011 were treated with NIV according to a pre-established protocol. Clinical variables were collected at baseline and at 1, 2, 6, 12 and 24 h. Failure criterion was the need for endotracheal intubation. Failures were considered as “early” if occurring ≤6 h after NIV initiation, “intermediate” if occurring between 6 and 24 h, and “late” if occurring after 24 h. Variables with a p < 0.1 in univariate analysis corrected by age were included in multivariate analysis. Models were calculated based on multivariate analysis.

Results

During the study period, 390 episodes were included. NIV success rate was 81.3 %. Among ARF causes, failure occurred most frequently in ARDS episodes. The failure predictive model for the whole sample included SF ratio at 1 h, age and PRISM III-24 (area under the curve AUC of 0.755). For early NIV failures, SF ratio at 1 h was the only variable within model (AUC 0.748). The analysis of intermediate NIV failures identified 3 variables independently linked to NIV outcome: PRISM III-24, RR decrease at 6 h, and SF ratio at 6 h (AUC 0.895). No model was identified for late NIV failure.

Conclusions

SF ratio is a reliable predictor of early NIV failure in children.

Keywords

References

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