Abstract
Noninvasive ventilation (NIV) is a common modality employed to treat acute respiratory
failure. Most data guiding its use is extrapolated from adult studies. We sought to
identify clinical predictors associated with failure of NIV, defined as requiring
intubation. This single-center retrospective observational study included children
admitted to pediatric intensive care unit (PICU) between July 2014 and June 2016 treated
with NIV, excluding postextubation. A total of 148 patients was included. Twenty-seven
(18%) failed NIV. There was no difference between the two groups with regard to age,
gender, comorbidities, or etiology of acute respiratory failure. Those that failed
had higher admission pediatric risk of mortality (p = 0.01) and pediatric logistic organ dysfunction (p = 0.002) scores and higher fraction of inspired oxygen (FiO2; p = 0.009) at NIV initiation. Failure was associated with lack of improvement in tachypnea.
At 6 hours of NIV, the failure group had worsening tachypnea with a median increase
in respiratory rate of 8%, while the success group had a median reduction of 18% (p = 0.06). Multivariable Cox's proportional hazard models revealed FiO2 at initiation and worsening respiratory rate at 1- and 6-hour significant risks for
failure of NIV. Failure was associated with a significantly longer PICU length of
stay (success [2.8 days interquartile range (IQR): 1.7, 5.5] vs. failure [10.6 days
IQR: 5.6, 13.2], p < 0.001). NIV can be successfully employed to treat acute respiratory failure in
pediatric patients. There should be heightened concern for NIV failure in hypoxemic
patients whose tachypnea is unresponsive to NIV. A trend toward improvement should
be closely monitored.
Keywords
critical care - acute respiratory failure - pediatric acute respiratory distress syndrome
- noninvasive ventilation - BiPAP - CPAP
