Early factors related to mortality in children treated with bi‐level noninvasive ventilation and CPAP

Abstract

Objective To describe and analyze the characteristics and the early risk factors for mortality of noninvasive ventilation (NIV) in critically ill children. Study design A multicenter, prospective, observational 2‐year study carried out with critically ill patients (1 month – 18 years of age) who needed NIV. Clinical data and NIV parameters during the first 12 h of admission were collected. A multilevel mixed‐effects logistic regression was performed to identify mortality risk factors. Results A total of 781 patients (44.2 ± 57.7 months) were studied (57.8% male). Of them, 53.7% had an underlying condition, and 47.1% needed NIV for lower airway respiratory pathologies. Bi‐level NIV was the initial support in 78.2% of the patients. Continuous positive airway pressure (CPAP) was used more in younger patients (33.7%) than in older ones (9.7%; p < .001). About 16.7% had to be intubated and 6.2% died. The risk factors for mortality were immunodeficiency (odds ratio [OR] = 11.79; 95% confidence interval [CI] = 2.95–47.13); cerebral palsy (OR = 5.86; 95% CI = 1.94–17.65); presence of apneas on admission (OR = 5.57; 95% CI = 2.13–14.58); tachypnea 6 h after NIV onset (OR = 2.59; 95% CI = 1.30–6.94); and NIV failure (OR = 6.54; 95% CI = 2.79–15.34). Conclusion NIV is used with great variability in types of support. Younger children receive CPAP more frequently than older children. Immunodeficiency, cerebral palsy, apneas on admission, tachypnea 6 h after NIV onset, and NIV failure are the early factors associated with mortality.

Reduced Air Leakage During Non-Invasive Ventilation Using a Simple Anesthetic Mask With 3D-Printed Adaptor in an Anthropometric Based Pediatric Head–Lung Model

“…The use of non-invasive ventilation (NIV) in the pediatric intensive care unit (PICU) to provide respiratory support for children of all ages has increased substantially over the past three decades ( 1 – 5 ). NIV can be a good alternative for invasive mechanical ventilation, which necessitates an artificial airway, in selected pediatric patients, including those with acute, moderate (hypoxic) respiratory failure.…”

“…Moreover, painful pressure ulcers may arise even after short-term use ( 10 , 15 , 18 , 19 ). Such complications contribute to the failure of NIV treatment, which occurs in up to 15–30% of pediatric cases in the PICU ( 5 , 20 ).…”

Noninvasive Respiratory Support for Pediatric Acute Respiratory Distress Syndrome: From the Second Pediatric Acute Lung Injury Consensus Conference

“…Noninvasive respiratory support is the use of oxygen or air to support a child’s breathing without inserting an invasive airway (1–21). These modalities include both noninvasive ventilation (NIV) and high-flow nasal cannula (HFNC).…”

“…NIV is increasingly used in children with severe respiratory disease to avoid intubation and its associated morbidities (1–21). The increased use of NIV in pediatric critical care has also been associated with improved outcomes including a decrease in the number of patients intubated and invasively ventilated, a reduction in duration of PICU length of stay (LOS), and reduced mortality (14, 16).…”