Vera Bernet1, Maja I Hug, Bernhard Frey. 1. Department of Neonatology and Intensive Care, University Children's Hospital, Zurich, Switzerland.
Abstract
OBJECTIVE: Noninvasive mask ventilation (NIV) is a treatment option in acute respiratory failure in adults. This study was performed to determine prognostic variables for the success of NIV in a group of infants and children with respiratory failure for a wide range of reasons. DESIGN: Prospective, clinical study. SETTING: Multidisciplinary, neonatal-pediatric intensive care unit of a university teaching hospital. METHODS: Descriptive study of infants and children <or=16 yrs of age with acute respiratory failure requiring assisted ventilation. During 2002-2003, patients with hypoxemic or hyper-carbic respiratory failure, signs of respiratory distress, and described by the attending critical care physician as likely to require intubation, were eligible to receive mask ventilation as an alternative means of respiratory support. Patients were not selected for their underlying disease contributing to the respiratory problems. Depending on whether they failed NIV and had to be intubated, the children were assigned to nonresponders or responders groups. The two groups were compared regarding physiologic variables prospectively evaluated before NIV and at 1, 8, 24, and 48 hrs of NIV. RESULTS: A total of 42 patients were included. Their median age was 2.45 yrs (range, 0.01-18 yrs). Twenty-one patients required mask ventilation only with continuous positive airway pressure and 21 with biphasic positive airway pressure. In both responders' and nonresponders' blood gas results, heart rate and respiratory rate improved significantly after initiation of NIV (p<.0001). The courses of these variables did not differentiate between the two groups. The overall success rate of NIV was 57%. After 1 hr of NIV, there was a significantly higher Fio2 in patients who failed NIV than in responders. An Fio2 of >80% after 1 hr of NIV predicted nonresponse with a sensitivity of 56%, specificity of 83%, and positive and negative predictive value of 71%. CONCLUSION: NIV can be successfully applied to infants and children with acute respiratory failure in the setting of a pediatric intensive care unit. The level of Fio2 after 1 hr of NIV may be a predictive factor for the treatment success.
OBJECTIVE: Noninvasive mask ventilation (NIV) is a treatment option in acute respiratory failure in adults. This study was performed to determine prognostic variables for the success of NIV in a group of infants and children with respiratory failure for a wide range of reasons. DESIGN: Prospective, clinical study. SETTING: Multidisciplinary, neonatal-pediatric intensive care unit of a university teaching hospital. METHODS: Descriptive study of infants and children <or=16 yrs of age with acute respiratory failure requiring assisted ventilation. During 2002-2003, patients with hypoxemic or hyper-carbic respiratory failure, signs of respiratory distress, and described by the attending critical care physician as likely to require intubation, were eligible to receive mask ventilation as an alternative means of respiratory support. Patients were not selected for their underlying disease contributing to the respiratory problems. Depending on whether they failed NIV and had to be intubated, the children were assigned to nonresponders or responders groups. The two groups were compared regarding physiologic variables prospectively evaluated before NIV and at 1, 8, 24, and 48 hrs of NIV. RESULTS: A total of 42 patients were included. Their median age was 2.45 yrs (range, 0.01-18 yrs). Twenty-one patients required mask ventilation only with continuous positive airway pressure and 21 with biphasic positive airway pressure. In both responders' and nonresponders' blood gas results, heart rate and respiratory rate improved significantly after initiation of NIV (p<.0001). The courses of these variables did not differentiate between the two groups. The overall success rate of NIV was 57%. After 1 hr of NIV, there was a significantly higher Fio2 in patients who failed NIV than in responders. An Fio2 of >80% after 1 hr of NIV predicted nonresponse with a sensitivity of 56%, specificity of 83%, and positive and negative predictive value of 71%. CONCLUSION: NIV can be successfully applied to infants and children with acute respiratory failure in the setting of a pediatric intensive care unit. The level of Fio2 after 1 hr of NIV may be a predictive factor for the treatment success.
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