Epidemiology of Noninvasive Ventilation in Pediatric Cardiac ICUs*

Abstract

Objective To describe the epidemiology of noninvasive ventilation (NIV) therapy for patients admitted to pediatric cardiac intensive care units (CICU), and to assess practice variation across hospitals. Design Retrospective cohort study using prospectively collected clinical registry data. Setting Pediatric Cardiac Critical Care Consortium (PC4) clinical registry. Patients Patients admitted to CICUs at PC4 hospitals. Interventions None. Measurements and Main Results We analyzed all CICU encounters that included any respiratory support from 10/2013-12/2015. NIV therapy included high flow nasal cannula (HFNC) and positive airway pressure (PAP) support. We compared patient and, when relevant, perioperative characteristics of those receiving NIV to all others. Subgroup analysis was performed on neonates and infants undergoing major cardiovascular surgery. To examine duration of respiratory support we created a casemix-adjustment model and calculated adjusted mean durations of total respiratory support (MV + NIV), MV, and NIV. We compared adjusted duration of support across hospitals. The cohort included 8,940 encounters from 15 hospitals: 3,950 (44%) received NIV, 72% were neonates and infants. Medical encounters were more likely to include NIV than surgical. In surgical neonates and infants, 2,032 (55%) received postoperative NIV. Neonates, extracardiac anomalies, single ventricle, procedure complexity, preoperative respiratory support, MV duration, and postoperative disease severity were associated with NIV therapy (p<0.001 for all). Across hospitals, NIV use ranged from 32%-65%, and adjusted mean NIV duration ranged from 1-4 days (3 days observed mean). Duration of total adjusted respiratory support was more strongly correlated with duration of MV compared to NIV (Pearson's r=0.93 vs 0.71, respectively). Conclusions NIV use is common in CICUs, especially in patients admitted for medical conditions, infants, and those undergoing high complexity surgery. We observed wide variation in NIV use across hospitals, though the primary driver of total respiratory support time seems to be duration of MV.

The final reason paediatric Cardiac ICU patients require care prior to discharge to the floor: a single-centre survey

“…Prior authors have described that neonates with CHD are more likely to have prolonged intubation [23][24][25] or use of non-invasive positive pressure ventilation following extubation. [26][27][28] Also, duration of ventilation directly impacts length of stay, as early extubation is associated with shorter length of stay. 29,30 Spring was also significantly associated with "Respiratory" Final ICU Need, which likely is influenced by the prevalence of respiratory illnesses persisting into the end of April in our region.…”

Accuracy of Administrative Codes for Distinguishing Positive Pressure Ventilation From High-Flow Nasal Cannula

“…[15][16][17][18][19] As a result, some authors combine both NIPPV and HHFNC when studying noninvasive respiratory support. 20,21 The overlap in definitions, physiologic effects, and patient populations who require escalated respiratory support in the form of HHFNC and NIPPV makes discriminating between the modalities for research purposes increasingly difficult.…”

Association between preoperative respiratory support and outcomes in paediatric cardiac surgery

“…This may be particularly relevant in children with significant pulmonary pathology, who may have traditionally been supported with invasive mechanical ventilation, but who may now be receiving noninvasive support instead. 20 It is also possible that greater use of preoperative noninvasive respiratory support in children with CHD in recent years has simply shifted the mortality risk of preoperative invasive respiratory support to the noninvasive support group. Given the potential for noninvasive support to reduce intubation-related morbidities, such as preoperative sedation or neuromuscular blockade-associated complications, this finding alone may be beneficial.…”