The Cause of Acute Respiratory Failure Predicts the Outcome of Noninvasive Ventilation in Immunocompromised Children

Fuchs, Hans; Schoss, J.; Mendler, Marc Robin; Lindner, Wolfgang; Hopfner, R.; Schulz, Alina; Hoenig, Manfred; Steinbach, Daniel; Debatin, Klaus‐Michael; Hummler, Helmut; Schmid, Manuel

doi:10.1055/s-0034-1395692

Cited by 7 publications

(11 citation statements)

References 27 publications

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“…There are some other studies focused on mortality in children with NIV 29–31 . These studies reported higher mortality rates (11.1%–59%) than ours, but they were carried out in selected subgroups of children.…”

Section: Discussioncontrasting

confidence: 50%

“…Moreover, their results were different when mortality was analyzed. While Zeng et al 29 in a multicenter retrospective cohort study focused on pediatric ARDS concluded that there were no differences in mortality rates between children with or without NIV failure, Crulli et al 31 and Fuchs et al 30 concluded that NIV failure was statistically associated with mortality. According to our data, NIV failure is an independent factor related to mortality in critically ill children with NIV, and those patients who failed NIV had a risk of dying 6.5 times greater than those who succeeded.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies, mostly single centered, have analyzed the predictive factors for NIV failure, among which are the severity of the illness, acute respiratory distress syndrome (ARDS), hypoxemia after 1 h of NIV, or the lack of improvement in tachypnea after 2 or 6 h of NIV 6,26–28 . Different studies have analyzed the factors related to mortality in children treated with NIV under different clinical situations 29–31 but a global vision about mortality and NIV is needed.…”

Section: Introductionmentioning

confidence: 99%

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Early factors related to mortality in children treated with bi‐level noninvasive ventilation and CPAP

López

Pons-Òdena

Medina

et al. 2021

Pediatric Pulmonology

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Objective To describe and analyze the characteristics and the early risk factors for mortality of noninvasive ventilation (NIV) in critically ill children. Study design A multicenter, prospective, observational 2‐year study carried out with critically ill patients (1 month – 18 years of age) who needed NIV. Clinical data and NIV parameters during the first 12 h of admission were collected. A multilevel mixed‐effects logistic regression was performed to identify mortality risk factors. Results A total of 781 patients (44.2 ± 57.7 months) were studied (57.8% male). Of them, 53.7% had an underlying condition, and 47.1% needed NIV for lower airway respiratory pathologies. Bi‐level NIV was the initial support in 78.2% of the patients. Continuous positive airway pressure (CPAP) was used more in younger patients (33.7%) than in older ones (9.7%; p < .001). About 16.7% had to be intubated and 6.2% died. The risk factors for mortality were immunodeficiency (odds ratio [OR] = 11.79; 95% confidence interval [CI] = 2.95–47.13); cerebral palsy (OR = 5.86; 95% CI = 1.94–17.65); presence of apneas on admission (OR = 5.57; 95% CI = 2.13–14.58); tachypnea 6 h after NIV onset (OR = 2.59; 95% CI = 1.30–6.94); and NIV failure (OR = 6.54; 95% CI = 2.79–15.34). Conclusion NIV is used with great variability in types of support. Younger children receive CPAP more frequently than older children. Immunodeficiency, cerebral palsy, apneas on admission, tachypnea 6 h after NIV onset, and NIV failure are the early factors associated with mortality.

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Section: Discussioncontrasting

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Early factors related to mortality in children treated with bi‐level noninvasive ventilation and CPAP

López

Pons-Òdena

Medina

et al. 2021

Pediatric Pulmonology

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“…Attending physicians of oncology and intensive care did not change during study time. New guidelines for intubation at lower thresholds were introduced at the very end of the second time period [41] and have, therefore, not contributed to the results. Furthermore, hypercapnia was introduced only, if the peak pressures exceeded 30 mm Hg and the daily increase in PCO 2 targets was roughly 10 mm Hg.…”

Section: Discussionmentioning

confidence: 99%

Permissive hypercapnia for severe acute respiratory distress syndrome in immunocompromised children: A single center experience

et al. 2017

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BackgroundControlled hypoventilation while accepting hypercapnia has been advocated to reduce ventilator-induced lung injury. The aim of the study was to analyze outcomes of a cohort of immunocompromised children with acute respiratory distress syndrome (ARDS) ventilated with a strategy of stepwise increasing PCO2 targets up to 140 mm Hg.MethodsRetrospective analysis of outcomes of a cohort of children with oncologic disease or after stem cell transplantation and severe respiratory failure in comparison with a historical control cohort.ResultsOut of 150 episodes of admission to the PICU 88 children underwent invasive mechanical ventilation for >24h (overall survival 75%). In a subgroup of 38 children with high ventilator requirements the PCO2 target ranges were increased stepwise. Fifteen children survived and were discharged from the PICU. Severe pulmonary hypertension was seen in two patients and no case of cerebral edema was observed. Long term outcome was available in 15 patients and 10 of these patients survived without adverse neurological sequelae. With introduction of this strategy survival of immunocompromised children undergoing mechanical ventilation for >24h increased to 48% compared to 32% prior to introduction (historical cohort).ConclusionsA ventilation strategy incorporating very high carbon dioxide levels to allow for low tidal volumes and limited inspiratory pressures is feasible in children. Even severe hypercapnia may be well tolerated. No severe side effects associated with hypercapnia were observed. This strategy could potentially increase survival in immunocompromised children with severe ARDS.

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“…Literature to date describes an estimated incidence between 5% and 7% of pneumothorax or pneumomediastinum using NIV. [ 7 8 9 ] Controversy exists within the consideration of pneumomediastinum as an absolute contraindication in NIV. [ 10 11 12 13 14 ] Some authors[ 10 11 12 13 14 ] consider NIV as an absolute contraindication whereas others establish that it is a relative contraindication.…”

Section: Discussionmentioning

confidence: 99%

Severe subcutaneous emphysema and pneumomediastinum secondary to noninvasive ventilation support in status asthmaticus

González-García¹,

Rey²,

Medina³

et al. 2016

Indian Journal of Critical Care Medicine

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A 12-year-old male with status asthmaticus developed subcutaneous emphysema and pneumomediastinum. He was transferred to our unit, where he received noninvasive ventilation (NIV). This respiratory support technique is not an absolute contraindication in these cases. After 2 h on NIV, he worsened sharply and the subcutaneous emphysema got bigger suddenly. He needed invasive ventilation for 5 days. Final outcome was satisfactory. This case illustrates that it is mandatory to keep a high level of vigilance when using NIV in patients with air leaks.

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The Cause of Acute Respiratory Failure Predicts the Outcome of Noninvasive Ventilation in Immunocompromised Children

Abstract: The prognosis of ARF in immunocompromised children remains guarded independent of initial success or failure of NIV due to a high rate of recurrent ARF. Reversible causes like bacterial sepsis had a higher NIV response rate. Relevant side effects of NIV were observed.

Cited by 7 publications

References 27 publications

Early factors related to mortality in children treated with bi‐level noninvasive ventilation and CPAP

Early factors related to mortality in children treated with bi‐level noninvasive ventilation and CPAP

Permissive hypercapnia for severe acute respiratory distress syndrome in immunocompromised children: A single center experience

Severe subcutaneous emphysema and pneumomediastinum secondary to noninvasive ventilation support in status asthmaticus

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