Predictors of noninvasive ventilation success in children with acute respiratory failure

Bakalli, Ilirjana; Celaj, Ermela; Simaku, Artan; Kola, Ermira; Sallabanda, Sashenka

doi:10.1007/s00134-015-3769-2

Cited by 8 publications

(8 citation statements)

References 4 publications

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“…Other predictive factors that have been reported in the literature for pediatric NIV but were not included in this study are a higher PaO 2 /FiO 2 before NIV [33], hemodynamic response to NIV for success and a higher PaCO 2 for failure [34], low pH immediately after initiation of NIV as a predictor of failure [35], respiratory rate prior to NIV (James et al .) and the number of failing organs [36].…”

Section: Discussionmentioning

confidence: 99%

Predictors of early synchronized non-invasive ventilation failure for infants < 32 weeks of gestational age with respiratory distress syndrome

Handoka¹,

Azzam²,

Gobarah³

2019

aoms

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Introduction The current trend in management of preterm neonates with respiratory distress syndrome is to attempt noninvasive ventilation (NIV) to avoid endotracheal intubation. However, failure of noninvasive ventilation may lead to increased morbidity and mortality. There is a scarcity of studies establishing predictors for the usefulness of NIV in this age group. Our aim here was to determine the predictors of NIV in preterm infants with respiratory distress syndrome (RDS) treated with synchronized nasal intermittent positive pressure ventilation (SNIPPV) for initial respiratory support. Material and methods We conducted a follow-up study on 85 infants < 32 weeks of gestational age, and < 1500 g with RDS who received early SNIPPV. Perinatal history, physical characteristics, ventilatory settings, and arterial blood gas analysis results were collected. We recorded the failure rate and potential predictive factors of this failure. Results There were 12 (14.1%) patients who had SNIPPV failure. The SNIPPV failure group had multiple significantly different characteristics compared to the successful SNIPPV group including gestation age, birth weight, grading of disease, severity of respiratory distress, antenatal steroid use and various ventilatory settings. Further multivariate analysis revealed only 3 predictors in our patients: grade of RDS (OR = 4.48, p = 0.008), antenatal steroid use (OR = 1.09, p = 0.01) and mean airway pressure (OR = 1.98, p = 0.0001). Conclusions Failure of early NIV occurred in a small subset of our patients. Predictors of noninvasive ventilation failure may be a useful guide for decisions regarding intubation.

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Section: Discussionmentioning

confidence: 99%

Predictors of early synchronized non-invasive ventilation failure for infants < 32 weeks of gestational age with respiratory distress syndrome

Handoka¹,

Azzam²,

Gobarah³

2019

aoms

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“…The immediate effect of noninvasive ventilation on patients' respiration was observed at the very early stages of therapy: the successful trials were able to lower down their RR at least 10% within an hour. The changes in ventilation parameters appeared to be a significant indicator to observe therapy response [25]. In a previous study from Bakalli et al, children achieved success with a positive predictive value of 88.2% (95% CI: 72.5%-96.6%), when they were able to reduce their RR more than 10 respiration / minute in two hours [25].…”

Section: Discussionmentioning

confidence: 95%

“…The changes in ventilation parameters appeared to be a significant indicator to observe therapy response [25]. In a previous study from Bakalli et al, children achieved success with a positive predictive value of 88.2% (95% CI: 72.5%-96.6%), when they were able to reduce their RR more than 10 respiration / minute in two hours [25]. Similarly, Mayordomo-Colunga et al stated the absence of RR decline at 1st and 6th hours in NIPPV failure [26].…”

Section: Discussionmentioning

confidence: 99%

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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“…Those who failed had higher rates after 2 hours. 13 James et al in 2011 investigated 83 children submitted to NIV; 36% failed and were intubated. They included oncologic and septic patients.…”

Section: Discussionmentioning

confidence: 99%

Arterial Blood Lactate in Children Primarily Submitted to Noninvasive Ventilation: A Time-Dependent ROC Analysis

Luz

Silva

2020

Journal of Child Science

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The purpose of this study was to evaluate blood lactate measurements and failure to noninvasive ventilation (NIV) in children admitted to a pediatric intensive care unit. This was a retrospective observational single-center study performed between June 2016 and June 2017. Dynamic lactate indices and failure to NIV in 63 children < 18 years and > 1 month old were examined; we considered blood lactate analyses at time 0, 6, 24, and 48 hours. NIV failure group had a higher pediatric risk of mortality (PRISM) score. Lactate indices decreased over time in the success group (p < 0.001). The best area under the curve observed was 69%, at 48 hours. Considering all measurements, the area under the curve for time-dependent receiver-operating characteristic curve was 58.6%. This study demonstrated blood lactate indices evolution over time in children submitted to NIV.

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Predictors of noninvasive ventilation success in children with acute respiratory failure

Cited by 8 publications

References 4 publications

Predictors of early synchronized non-invasive ventilation failure for infants < 32 weeks of gestational age with respiratory distress syndrome

Predictors of early synchronized non-invasive ventilation failure for infants < 32 weeks of gestational age with respiratory distress syndrome

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

Arterial Blood Lactate in Children Primarily Submitted to Noninvasive Ventilation: A Time-Dependent ROC Analysis

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