Clinical Outcomes of Acute Respiratory Failure Associated With Noninvasive and Invasive Ventilation in a Pediatric ICU

Kyle, James M; Sturza, Julie; Dechert, Ronald E.; Custer, Joseph R.; Dahmer, Mary K.; Saba, Thomas G.; Flori, Heidi R.

doi:10.4187/respcare.09348

Cited by 1 publication

(1 citation statement)

References 29 publications

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“…More alarming, a recent large trial found that preintubation NIV in pediatric ARDS was associated with worse mortality rates (36). The finding was not confirmed in a more recent (but smaller) retrospective trial (37). Our findings cannot clarify the issue: in the wait for large RCTs on ARDS, NIV in this context should be applied very cautiously, and intubation should not be delayed.…”

Section: Discussioncontrasting

confidence: 65%

Noninvasive Ventilation for Acute Respiratory Failure in Pediatric Patients: A Systematic Review and Meta-Analysis

Boghi

Kim

et al. 2022

Pediatric Critical Care Medicine

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To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) on the use of noninvasive ventilation (NIV) for acute respiratory failure (ARF) in pediatric patients. DATA SOURCES:We searched PubMed, EMBASE, the Cochrane Central Register of Clinical Trials, and Clinicaltrials.gov with a last update on July 31, 2022. STUDY SELECTION:We included RCTs comparing NIV with any comparator (standard oxygen therapy and high-flow nasal cannula [HFNC]) in pediatric patients with ARF. We excluded studies performed on neonates and on chronic respiratory failure patients.DATA EXTRACTION: Baseline characteristics, intubation rate, mortality, and hospital and ICU length of stays were extracted by trained investigators. DATA SYNTHESIS:We identified 15 RCTs (2,679 patients) for the final analyses. The intubation rate was 109 of 945 (11.5%) in the NIV group, and 158 of 1,086 (14.5%) in the control group (risk ratio, 0.791; 95% CI, 0.629-0.996; p = 0.046; I 2 = 0%; number needed to treat = 31). Findings were strengthened after removing studies with intervention duration shorter than an hour and after excluding studies with cross-over as rescue treatment. There was no difference in mortality, and ICU and hospital length of stays. CONCLUSIONS:In pediatric patients, NIV applied for ARF might reduce the intubation rate compared with standard oxygen therapy or HFNC. No difference in mortality was observed.

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Section: Discussioncontrasting

confidence: 65%