Juan Mayordomo-Colunga1, Martí Pons-Òdena2, Alberto Medina1, Corsino Rey1, Christophe Milesi3, Merja Kallio4, Andrea Wolfler5, Mireia García-Cuscó6, Demet Demirkol7, Milagros García-López8, Peter Rimensberger9. 1. Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Spain. 2. Critical Care Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain Pediatric Intensive Care and Intermediate Care Department, Sant Joan de Déu University Hospital, Universitat de Barcelona, Esplugues de Llobregat, Spain. 3. Pediatric Intensive Care Unit, Academic Hospital Arnaud de Villeneuve, Montpellier, France. 4. PEDEGO Research Group, University of Oulu, Pediatric Department, Oulu University Hospital, Oulu, Finland. 5. Intensive Care Unit, Department of Pediatrics, Children's Hospital V Buzzi, Milan, Italy. 6. Pediatric Intensive Care Unit, Bristol Royal Hospital for Children, Bristol, United Kingdom. 7. Department of Pediatric Intensive Care, Koç University School of Medicine, Istanbul, Turkey. 8. Pediatric Intensive Care Unit, Department of Pediatrics, São João Hospital, Porto, Portugal. 9. Service of Neonatology and Pediatric Intensive Care, Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland.
Abstract
OBJECTIVES: To describe the diversity in practice in non-invasive ventilation (NIV) in European pediatric intensive care units (PICUs). WORKING HYPOTHESIS: No information about the use of NIV in Pediatrics across Europe is currently available, and there might be a wide variability regarding the approach. STUDY DESIGN: Cross-sectional electronic survey. METHODOLOGY: The survey was distributed to the ESPNIC mailing list and to researchers in different European centers. RESULTS: One hundred one units from 23 countries participated. All respondent units used NIV. Almost all PICUs considered NIV as initial respiratory support (99.1%), after extubation (95.5% prophylactically, 99.1% therapeutically), and 77.5% as part of palliative care. Overall NIV use outside the PICUs was 15.5% on the ward, 20% in the emergency department, and 36.4% during transport. Regarding respiratory failure cause, NIV was delivered in pneumonia (97.3%), bronchiolitis (94.6%), bronchospasm (75.2%), acute pulmonary edema (84.1%), upper airway obstruction (76.1%), and in acute respiratory distress syndrome (91% if mild, 53.1% if moderate, and 5.3% if severe). NIV use in asthma was less frequent in Northern European units in comparison to Central and Southern European PICUs (P = 0.007). Only 47.7% of the participants had a written protocol about NIV use. Bilevel NIV was applied mostly through an oronasal mask (44.4%), and continuous positive airway pressure through nasal cannulae (39.8%). If bilevel NIV was required, 62.3% reported choosing pressure support (vs assisted pressure-controlled ventilation) in infants; and 74.5% in older children. CONCLUSIONS: The present study shows that NIV is a widespread technique in European PICUs. Practice across Europe is variable.
OBJECTIVES: To describe the diversity in practice in non-invasive ventilation (NIV) in European pediatric intensive care units (PICUs). WORKING HYPOTHESIS: No information about the use of NIV in Pediatrics across Europe is currently available, and there might be a wide variability regarding the approach. STUDY DESIGN: Cross-sectional electronic survey. METHODOLOGY: The survey was distributed to the ESPNIC mailing list and to researchers in different European centers. RESULTS: One hundred one units from 23 countries participated. All respondent units used NIV. Almost all PICUs considered NIV as initial respiratory support (99.1%), after extubation (95.5% prophylactically, 99.1% therapeutically), and 77.5% as part of palliative care. Overall NIV use outside the PICUs was 15.5% on the ward, 20% in the emergency department, and 36.4% during transport. Regarding respiratory failure cause, NIV was delivered in pneumonia (97.3%), bronchiolitis (94.6%), bronchospasm (75.2%), acute pulmonary edema (84.1%), upper airway obstruction (76.1%), and in acute respiratory distress syndrome (91% if mild, 53.1% if moderate, and 5.3% if severe). NIV use in asthma was less frequent in Northern European units in comparison to Central and Southern European PICUs (P = 0.007). Only 47.7% of the participants had a written protocol about NIV use. Bilevel NIV was applied mostly through an oronasal mask (44.4%), and continuous positive airway pressure through nasal cannulae (39.8%). If bilevel NIV was required, 62.3% reported choosing pressure support (vs assisted pressure-controlled ventilation) in infants; and 74.5% in older children. CONCLUSIONS: The present study shows that NIV is a widespread technique in European PICUs. Practice across Europe is variable.
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