Post-extubation non-invasive ventilation in the pediatric intensive care unit: a multicenter study

Bonora, Juan Pablo; Frydman, Judith; Retta, Alejandra; Canepari, A.

doi:10.5546/aap.2018.eng.333

Cited by 4 publications

(5 citation statements)

References 14 publications

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“…Several models also predict HFNC failure such as RR above the 90th percentile for age at triage [1,27], no RR or HR change within sixty minutes [28] and worsening pediatric early warning scores [29]. The failure rate (13.4%) in this study was within the reported ranges of 3% and 30% [3,8,30]. Neither the treatment modality (NIPPV / HFNC) nor the therapy institution (first-line / rescue therapy) was associated with NIV failure.…”

Section: Discussionmentioning

confidence: 55%

“…Complex chronic conditions inevitably influence the ventilation strategies [8,19,33]. SCARF (Early CPAP in Acute Respiratory Failure) study is a recent, randomized, controlled study performed in children with a high-risk combination of impaired immunity and ARF [37].…”

Section: Discussionmentioning

confidence: 99%

“…Our local practices favored the application of specific noninvasive ventilator devices (capable of compensating high leakage) with the use of full-face masks. Recent advances in manufacturing industry, different-sized masks enable more applicable, patient-friendly utilization at all ages [8].…”

Section: Discussionmentioning

confidence: 99%

“…The efficiency has been studied in several clinical conditions including acute pneumonia [5], bronchiolitis [6], status asthmaticus [7] and post-extubation respiratory failure [8]. Physiological studies also confirm the positive influence on respiratory functions [9,10].…”

Section: Introductionmentioning

confidence: 91%

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A multicentered study on efficiency of noninvasive ventilation procedures (SAFE-NIV)

et al. 2021

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Background/aim: To characterize the clinical course of noninvasive positive pressure ventilation (NIPPV) and high flow humidified nasal cannula ventilation (HFNC) procedures; perform risk analysis for ventilation failure. Material and methods: This prospective, multi-centered, observational study was conducted in 352 PICU admissions (1 month-18 years) between 2016 and 2017. SPSS-22 was used to assess clinical data, define thresholds for ventilation parameters and perform risk analysis. Results: Patient age, onset of disease, previous intubation and hypoxia influenced the choice of therapy mode: NIPPV was preferred in older children (p = 0.002) with longer intubation (p < 0.001), ARDS (p = 0.001), lower respiratory tract infections (p < 0.001), chronic respiratory disease, (p = 0.005), malignancy (p = 0.048) and immune deficiency (p = 0.026).The failure rate was 13.4%. Sepsis, ARDS, prolonged intubation and use of nasal masks were associated with NIV failure (p = 0.001, p < 0.001, p < 0.001, p = 0.025). The call of intubation or re-intubation was given due to respiratory failure in twenty-seven (57.5%), hemodynamic instability in eight (17%), bulbar dysfunction or aspiration in five (10.6%), neurological deterioration in four (8.5%) and developing ARDS in three (6.4%) children. A reduction of less than 10% in the respiration within an hour increased the odds of failure by 9.841 times (OR:9.841, 95% CI: 2.0021-48.3742). FiO 2 >55% at 6 th hours and PRISM-3 >8 were other failure predictors. Of the 9.9% complication rate, the most common complication was pressure ulcerations (4.8%) and mainly observed when using full-face masks (p = 0.047). Fifteen (4.3%) patients died of miscellaneous causes. Tracheostomy cannulation was performed on sixteen children due to prolonged mechanical ventilation (8% in NIPPV, 2.6% in HFNC) Conclusion: Absence of reduction in the respiration rate within an hour, FiO 2 requirement >55% at 6 th hours and PRISM-3 score >8 predict NIV failure.

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Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 91%

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A multicentered study on efficiency of noninvasive ventilation procedures (SAFE-NIV)

et al. 2021

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“…Weaning from mechanical ventilation (MV) can be defined as the gradual reduction in respiratory support, assigning a spontaneous breathing time to let the child take responsibility for an acceptable gas exchange [3]. The term extubation failure (EF) represents a set of conditions that determine the need for reintubation and MV restoration within the first 24-72h after the removal of the endotracheal tube [3,4]. Non-invasive mechanical ventilation (NIMV) offers an alternative to intubation with possibility of providing MV in the treatment of acute respiratory failure in infants and children [1] and helps restore diaphragm function as soon as possible in case of good patient-machine synchronization.…”

Section: Problem Statement and Analysis Of The Latest Researchmentioning

confidence: 99%

Non-Invasive Mechanical Ventilation in Children with Previous Unsuccessful Weaning from Respiratory Therapy

Filyk

2020

Galician med. j.

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The objective of the research was to establish the impact of diaphragm-protective mechanical ventilation on the rate of successful weaning from invasive and non-invasive mechanical ventilation in children with acute respiratory failure. Materials and Methods. We conducted a prospective, observational cohort study. Seventy-eight patients were randomly divided into 2 groups: patients of Group I received lung-protective mechanical ventilation; patients of Group II received diaphragm-protective + lung-protective mechanical ventilation. For age-specific data analysis, patients were divided into age subgroups: the 1st subgroup included children being 1 to 12 months old; the 2nd age subgroup comprised children being 12 to 36 months old. We started respiratory support in both groups with invasive mechanical ventilation and when patients met the criteria, we weaned them. We confirmed successful weaning, when patients had no need to be mechanically ventilated within next 48 hours, otherwise, they were intubated again. Before the second trial to wean, patients in Group I were simply extubated, while patients in Group II received non-invasive mechanical ventilation. The primary endpoint was the rate of successful weaning from mechanical ventilation in the first trial. The secondary outcomes were complications, namely reintubation rate, tracheostomy rate and death. Results. We found a significant difference in the primary outcome for the 1st age subgroup: there were 72.4% in Group I vs. 52.6% in Group II successfully weaned patients (p=0.04). No significant difference in the primary outcome was observed in the 2nd age subgroup: there were 80% in Group I vs. 82.3% in Group II successfully weaned patients (p=0.78). There were significant differences in the secondary outcomes between groups in the 1st age subgroup, namely reintubation rate was seen in 9.1% patients of Group I vs. 36.8% patients of Group II (p=0.05); death happened in 18.2% cases in Group I vs. no cases in Group II (p=0.01). There were no differences in tracheostomy rate in the 1st age subgroup and there were no differences in the secondary outcomes between groups in 2nd age subgroup. Conclusions. Diaphragm-protective mechanical ventilation significantly reduced the incidence of successful weaning from invasive mechanical ventilation; however, it increased the incidence of successful weaning from non-invasive mechanical ventilation, and, significantly decreased the mortality rate in the 1st age subgroup, while in the 2nd age subgroup, it had no impact on the incidence of successful weaning from invasive mechanical ventilation and mortality rate.

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Weaning from ventilation and extubation of children in critical care

Egbuta¹,

Evans²

2022

BJA Education

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Post-extubation non-invasive ventilation in the pediatric intensive care unit: a multicenter study

Cited by 4 publications

References 14 publications

A multicentered study on efficiency of noninvasive ventilation procedures (SAFE-NIV)

A multicentered study on efficiency of noninvasive ventilation procedures (SAFE-NIV)

Non-Invasive Mechanical Ventilation in Children with Previous Unsuccessful Weaning from Respiratory Therapy

Weaning from ventilation and extubation of children in critical care

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