Predictive factors of non invasive ventilation failure in critically ill children: a prospective epidemiological study
Juan Mayordomo-Colunga, Alberto Medina, Corsino Rey, Juan José Díaz, Andrés Concha, Marta Los Arcos, Sergio Menéndez
Pediatric Original
Online First ™ -
November ,
2008
Pages 1 - 10
Abstract
Objective
Identification of predictive factors for non-invasive ventilation (NIV) failure and determination of NIV characteristics.
Design
Prospective observational study.
Setting
Paediatric Intensive Care Unit in a University Hospital.
Patients and measurements
A total of 116 episodes were included. Clinical data collected were respiratory rate (RR), heart rate and FiO2 before NIV began. Same data and expiratory and support pressures were collected at 1, 6, 12, 24 and 48 h. Conditions precipitating acute respiratory failure (ARF) were classified into two groups: type 1 (38 episodes) and type 2 (78 episodes). Ventilation–perfusion impairment was the main respiratory failure mechanism in type 1, and hypoventilation in type 2. Factors predicting NIV failure were determined by multivariate analysis.
Results
Most common admission diagnoses were pneumonia (81.6%) in type 1 and bronchiolitis (39.7%) and asthma (42.3%) in type 2. Complications secondary to NIV were detected in 23 episodes (20.2%). NIV success rate was 84.5% (68.4% in type 1 and 92.3% in type 2). Type 1 patients showed a higher risk of NIV failure compared to type 2 (OR 11.108; CI 95%, 2.578–47.863). A higher PRISM score (OR 1.138; CI 95%, 1.022–1.267), and a lower RR decrease at 1 h and at 6 h (OR 0.926; CI 95%, 0.860–0.997 and OR 0.911; CI 95%, 0.837–0.991, respectively) were also independently associated with NIV failure.
Conclusions
NIV is a useful respiratory support technique in paediatric patients. Type 1 group classification, higher PRISM score, and lower RR decrease during NIV were independent risk factors for NIV failure.
Keywords
References
- Meduri GU (1996) Noninvasive positive-pressure ventilation in patients with acute respiratory failure. Clin Chest Med 17:513–553
- Mehta S, Hill NS (2001) Noninvasive ventilation. Am J Respir Crit Care Med 163:540–577
- Celikel T, Sungur M, Ceyhan B, Karakurt S (1998) Comparison of noninvasive positive pressure ventilation with standard medical therapy in hypercapnic acute respiratory failure. Chest 114:1636–1642
- Thys F, Roeseler J, Reynaert M, Liistro G, Rodenstein DO (2002) Noninvasive ventilation for acute respiratory failure: a prospective randomised placebo-controlled trial. Eur Respir J 20:545–555
- Chadda K, Annane D, Hart N, Gajdos P, Raphael JC, Lofaso F (2002) Cardiac and respiratory effects of continuous positive airway pressure and noninvasive ventilation in acute cardiac pulmonary edema. Crit Care Med 30:2457–2461
- Confalonieri M, Potena A, Carbone G, Porta RD, Tolley EA, Umberto MG (1999) Acute respiratory failure in patients with severe community-acquired pneumonia. A prospective randomized evaluation of noninvasive ventilation. Am J Respir Crit Care Med 160:1585–1591
- Hilbert G, Gruson D, Vargas F, Valentino R, Gbikpi-Benissan G, Dupon M, Reiffers J, Cardinaud JP (2001) Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. N Engl J Med 344:481–487
- Antonelli M, Conti G, Moro ML, Esquinas A, Gonzalez-Diaz G, Confalonieri M, Pelaia P, Principi T, Gregoretti C, Beltrame F, Pennisi MA, Arcangeli A, Proietti R, Passariello M, Meduri GU (2001) Predictors of failure of noninvasive positive pressure ventilation in patients with acute hypoxemic respiratory failure: a multi-center study. Intensive Care Med 27:1718–1728
- Antonelli M, Conti G, Esquinas A, Montini L, Maggiore SM, Bello G, Rocco M, Maviglia R, Pennisi MA, Gonzalez-Diaz G, Meduri GU (2007) A multiple-center survey on the use in clinical practice of noninvasive ventilation as a first-line intervention for acute respiratory distress syndrome. Crit Care Med 35:18–25
- Delclaux C, L’Her E, Alberti C, Mancebo J, Abroug F, Conti G, Guerin C, Schortgen F, Lefort Y, Antonelli M, Lepage E, Lemaire F, Brochard L (2000) Treatment of acute hypoxemic nonhypercapnic respiratory insufficiency with continuous positive airway pressure delivered by a face mask: A randomized controlled trial. JAMA 284:2352–2360
- Keenan SP, Powers C, McCormack DG, Block G (2002) Noninvasive positive-pressure ventilation for postextubation respiratory distress: a randomized controlled trial. JAMA 287:3238–3244
- Esteban A, Frutos-Vivar F, Ferguson ND, Arabi Y, Apezteguia C, Gonzalez M, Epstein SK, Hill NS, Nava S, Soares MA, D’Empaire G, Alia I, Anzueto A (2004) Noninvasive positive-pressure ventilation for respiratory failure after extubation. N Engl J Med 350:2452–2460
- Martin TJ, Hovis JD, Costantino JP, Bierman MI, Donahoe MP, Rogers RM, Kreit JW, Sciurba FC, Stiller RA, Sanders MH (2000) A randomized, prospective evaluation of noninvasive ventilation for acute respiratory failure. Am J Respir Crit Care Med 161:807–813
- Nourdine K, Combes P, Carton MJ, Beuret P, Cannamela A, Ducreux JC (1999) Does noninvasive ventilation reduce the ICU nosocomial infection risk? A prospective clinical survey. Intensive Care Med 25:567–573
- Carlucci A, Richard JC, Wysocki M, Lepage E, Brochard L (2001) Noninvasive versus conventional mechanical ventilation. An epidemiologic survey. Am J Respir Crit Care Med 163:874–880
- Courtney SE, Barrington KJ (2007) Continuous positive airway pressure and noninvasive ventilation. Clin Perinatol 34:73–92 vi
- Dani C, Bertini G, Pezzati M, Cecchi A, Caviglioli C, Rubaltelli FF (2004) Early extubation and nasal continuous positive airway pressure after surfactant treatment for respiratory distress syndrome among preterm infants <30 weeks’ gestation. Pediatrics 113:e560–e563
- López M, Pallás CR, Muñoz MC, Barrio MC, Medina C, de la Cruz J (2006) The use of the continuous positive airway pressure for early stabilization in very low birthweight infants. An Pediatr (Barc) 64:422–427
- Verder H (2007) Nasal CPAP has become an indispensable part of the primary treatment of newborns with respiratory distress syndrome. Acta Paediatr 96:482–484
- Essouri S, Chevret L, Durand P, Haas V, Fauroux B, Devictor D (2006) Noninvasive positive pressure ventilation: five years of experience in a pediatric intensive care unit. Pediatr Crit Care Med 7:329–334
- Joshi G, Tobias JD (2007) A five-year experience with the use of BiPAP in a pediatric intensive care unit population. J Intensive Care Med 22:38–43
- Fortenberry JD, Del TJ, Jefferson LS, Evey L, Haase D (1995) Management of pediatric acute hypoxemic respiratory insufficiency with bilevel positive pressure (BiPAP) nasal mask ventilation. Chest 108:1059–1064
- Padman R, Lawless S, Von NS (1994) Use of BiPAP by nasal mask in the treatment of respiratory insufficiency in pediatric patients: preliminary investigation. Pediatr Pulmonol 17:119–123
- Carroll CL, Schramm CM (2006) Noninvasive positive pressure ventilation for the treatment of status asthmaticus in children. Ann Allergy Asthma Immunol 96:454–459
- Medina A, Prieto S, Los Arcos M, Rey C, Concha A, Menendez S (2005) Noninvasive ventilation in a pediatric intensive care unit. An Pediatr (Barc) 62:13–19
- Piastra M, Antonelli M, Chiaretti A, Polidori G, Polidori L, Conti G (2004) Treatment of acute respiratory failure by helmet-delivered non-invasive pressure support ventilation in children with acute leukemia: a pilot study. Intensive Care Med 30:472–476
- Akingbola OA, Simakajornboon N, Hadley EF Jr, Hopkins RL (2002) Noninvasive positive-pressure ventilation in pediatric status asthmaticus. Pediatr Crit Care Med 3:181–184
- Mayordomo J, Fernández-Barrio B, Medina A, Rey C, Prieto S, Concha A (2007) Evaluation of noninvasive ventilation success or failure. Pediatr Crit Care Med 8(3 Suppl):A266
- Piastra M, Antonelli M, Caresta E, Chiaretti A, Polidori G, Conti G (2006) Noninvasive ventilation in childhood acute neuromuscular respiratory failure: a pilot study. Respiration 73:791–798
- Padman R, Lawless ST, Kettrick RG (1998) Noninvasive ventilation via bilevel positive airway pressure support in pediatric practice. Crit Care Med 26:169–173
- Larrar S, Essouri S, Durand P, Chevret L, Haas V, Chabernaud JL, Leyronnas D, Devictor D (2006) Effects of nasal continuous positive airway pressure ventilation in infants with severe acute bronchiolitis. Arch Pediatr 13:1397–1403
- Campion A, Huvenne H, Leteurtre S, Noizet O, Binoche A, Diependaele JF, Cremer R, Fourier C, Sadik A, Leclerc F (2006) Non-invasive ventilation in infants with severe infection presumably due to respiratory syncytial virus: feasibility and failure criteria. Arch Pediatr 13:1404–1409
- Teague WG (2003) Noninvasive ventilation in the pediatric intensive care unit for children with acute respiratory failure. Pediatr Pulmonol 35:418–426
- Bernet V, Hug MI, Frey B (2005) Predictive factors for the success of noninvasive mask ventilation in infants and children with acute respiratory failure. Pediatr Crit Care Med 6:660–664
- L’Her E, Deye N, Lellouche F, Taille S, Demoule A, Fraticelli A, Mancebo J, Brochard L (2005) Physiologic effects of noninvasive ventilation during acute lung injury. Am J Respir Crit Care Med 172:1112–1118
- Peñuelas O, Frutos-Vivar F, Esteban A (2007) Noninvasive positive-pressure ventilation in acute respiratory failure. CMAJ 177:1211–1218
- Ream RS, Loftis LL, Albers GM, Becker BA, Lynch RE, Mink RB (2001) Efficacy of IV theophylline in children with severe status asthmaticus. Chest 119:1480–1488
- Martinon-Torres F, Rodriguez-Nunez A, Martinon-Sanchez JM (2002) Heliox therapy in infants with acute bronchiolitis. Pediatrics 109:68–73
- Pons M, Cambra A (2003) Noninvasive ventilation. An Pediatr (Barc) 59:165–172