Noninvasive Positive Pressure Ventilation in Critically Ill Children With Cardiac Disease

Abstract

Noninvasive ventilation is effective in respiratory failure from various etiologies. This study aimed to analyze the efficacy of noninvasive positive pressure ventilation (NPPV) in pediatric cardiac patients. NPPV was used (1) as an alternative means of respiratory support in patients with hypoxemic or hypercarbic respiratory failure or with signs of respiratory distress that were considered to require intubation; or (2) as a preventive measure in patients with high risk for extubation failure. Between 2008 and 2011, there were 107 episodes of NPPV use in 82 patients. Their median age was 57 days (range 1 day to 18 years), and weight was 4.1 kg (range 1.7-68). Within the first hour of NPPV, partial pressure of carbon dioxide/fraction of inspired oxygen (PaO2/FiO2) was significantly increased, and arterial pCO2, and respiratory rate were decreased. This decrease in respiratory rate and increase in PaO 2/FiO2 continued during the first 24 h of therapy, and pCO2 was decreased during the first 6 h. In 59.8% of cases, NPPV was successfully used without the need for tracheal intubation. The Aristotle Basic Complexity score, presence of infection, residual cardiac defect, and pH <7.36 in the first hour were independent predictors of NPPV failure. We conclude that NPPV improved oxygenation and decreased respiratory effort in pediatric cardiac patients, 59.8% of whom eventually did not receive intubation. A high-complexity surgical score, presence of infection, residual cardiac defect, and pH <7.36 in the first hour are predictors of NPPV failure, which occurs in most patients >24 h after the onset of therapy.

Epidemiology of Noninvasive Ventilation in Pediatric Cardiac ICUs*

“…Previous single center studies have shown NIV to be an effective mode of respiratory support in the management of children with heart disease [6], including following cardiac surgery [4, 7, 8]. Our study represents the most comprehensive description to-date of NIV therapy in contemporary pediatric cardiac critical care, and the first to assess NIV therapy in a multi-institutional cohort.…”

“…Previous single-center studies demonstrate the safety and effectiveness of NIV in the management of respiratory insufficiency in infants and children [1-3], including those undergoing cardiac surgery [4-8]. NIV therapy may hold promise to decrease ICU length of stay, complications associated with invasive respiratory support, and improve other clinical outcomes for patients in the CICU by allowing reduction in mechanical ventilation (MV).…”

“…The basic clinical epidemiology of NIV utilization - which patients receive NIV, typical duration of therapy, and use of specific types of NIV therapies - has never been studied in a large cohort of critically ill children with cardiovascular disease. Furthermore, as most of the existing data come from single center studies [4-8], very little is known about how use may vary across hospitals. Finally, the relative contribution from NIV and MV to the total respiratory support time of patients in the CICU remains unknown.…”

Preventive and therapeutic noninvasive ventilation in cardiovascular surgery

“…Kovacicova et al [29] performed an observational, prospective, single-center study, including 107 episodes of NIV application in children with cardiac disease: 87% of the episodes occurred after cardiac surgery. Patient mean age was 57 days, with mean weight 4.1 kg.…”

El niño con Síndrome de Down en la Unidad de Cuidados Intensivos

“…La progresiva incorporación del uso de ventilación no invasiva ha proporcionado una mejoría clínica significativa en los pacientes con falla cardiaca congestiva e hipertensión pulmonar y un probable impacto benéfico en la mortalidad 40 . Finalmente, se ha demostrado en importantes estudios de cohorte que el neonato y niño con SD presenta el mismo 9 o menor riesgo de muerte a corto plazo 41 que el niño sin SD post cardiocirugía.…”