Risk factors for the failure of nasal noninvasive ventilation in infants with severe community acquired pneumonia: a case-control study

Abstract

Purpose To investigate the risk factors for the failure of nasal noninvasive ventilation (NIV) in infants with severe community acquired pneumonia (SCAP). Methods This was a case-control study from the Pediatric Intensive Care Unit of the National Children’s Regional Medical Center in Northeast China. Comprehensive data was sourced from all infants (28 days − 3 years) diagnosed with SCAP and using NIV as the initial ventilation therapy from 2017 to 2021. NIV failure referred to endotracheal intubation, infant death or termination of treatment. Results Among the 168 infants, the failure rate of NIV was 47.0%. After adjusting by a binary logistic regression model, neuromuscular disorder (NMD) (odds ratio 6.47, 95% confidence interval 1.06–39.56), alanine aminotransferase (ALT) (2.25, 1.15–4.39), the differences of respiratory rate-oxygenation (ΔROX) index < -0.41 (2.20, 1.06–4.55), the duration before start NIV (0.97, 0.94–0.99), and the initial FIO2 of NIV (1.05, 1.02–1.09) were associated with NIV failure (all P values < 0.05). The predictive ability of PRISM III score (area under curve 0.588, P = 0.049) and modified PIRO scale (0.615, P = 0.010) for intubation were significant, not included PELOD-2 score (0.584, P = 0.060). 19.0% (15/79) infants experienced late intubation (> 72 hours of admission), which correlated to a lower improvement rate (76.6% vs. 40.0%, P = 0.011). Conclusions NMD history, reduced ΔROX index, increased ALT, early use and higher initial FIO2 requirements for NIV were risk factors for intubation during NIV for infants.