Juan P Bonora1, Judith Frydman2, Alejandra Retta3, Andrea Canepari4. 1. Hospital de Pediatría "Prof. Dr. Juan P. Garrahan". juampabon@yahoo.com.ar. 2. Hospital Central de Pediatría de Malvinas Argentinas. 3. Hospital de Niños Dr. Ricardo Gutiérrez. 4. Hospital Italiano de Buenos Aires, Ciudad de Buenos Aires.
Abstract
INTRODUCTION: Extubation failure is a complication that increases morbidity and mortality. Noninvasive ventilation (NIV) has demonstrated to be effective as ventilatory support therapy. OBJECTIVE: To determine the rate of postextubation NIV success and the factors associated with procedural failure or success. POPULATION AND METHODS: Design: observational, retrospective, analytical, and multicenter study. All patients who required post-extubation NIV during 2014 and 2015 were included. Rescue NIV was defined as the implementation of NIV for acute respiratory failure; elective NIV was described as its implementation for prophylaxis. NIV failure was defined as the need for orotracheal intubation within the first 48 hours. The characteristics of failure and success and the types of NIV were compared, and the equipment used was assessed. RESULTS: Rescue NIV was required in 112 children; elective NIV, in 143. The rates of success were 68.8% and 72.7%, respectively. Mortality was higher among patients in whom rescue NIV failed compared to those with successful NIV. A longer length of stay and more days of invasive mechanical ventilation prior to extubation were observed in the elective NIV group. The most common diagnosis was acute lower respiratory tract infection in previously healthy children. CONCLUSIONS: The use of post-extubation NIV may be a useful tool to prevent reintubation with invasive mechanical ventilation. Immunocompromised patients and those with neurological history had a higher rate of failure. Patients with failure tolerated less hours of NIV and had a longer length of stay in the pediatric intensive care unit. Sociedad Argentina de Pediatría.
INTRODUCTION:Extubation failure is a complication that increases morbidity and mortality. Noninvasive ventilation (NIV) has demonstrated to be effective as ventilatory support therapy. OBJECTIVE: To determine the rate of postextubation NIV success and the factors associated with procedural failure or success. POPULATION AND METHODS: Design: observational, retrospective, analytical, and multicenter study. All patients who required post-extubation NIV during 2014 and 2015 were included. Rescue NIV was defined as the implementation of NIV for acute respiratory failure; elective NIV was described as its implementation for prophylaxis. NIV failure was defined as the need for orotracheal intubation within the first 48 hours. The characteristics of failure and success and the types of NIV were compared, and the equipment used was assessed. RESULTS: Rescue NIV was required in 112 children; elective NIV, in 143. The rates of success were 68.8% and 72.7%, respectively. Mortality was higher among patients in whom rescue NIV failed compared to those with successful NIV. A longer length of stay and more days of invasive mechanical ventilation prior to extubation were observed in the elective NIV group. The most common diagnosis was acute lower respiratory tract infection in previously healthy children. CONCLUSIONS: The use of post-extubation NIV may be a useful tool to prevent reintubation with invasive mechanical ventilation. Immunocompromised patients and those with neurological history had a higher rate of failure. Patients with failure tolerated less hours of NIV and had a longer length of stay in the pediatric intensive care unit. Sociedad Argentina de Pediatría.