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J Pediatr Intensive Care 2023; 12(03): 196-202
DOI: 10.1055/s-0041-1731433
Original Article

Predictors of Failure of Noninvasive Ventilation in Critically Ill Children

Alyson K. Baker 
1   Division of Pediatric Critical Care, Riley Hospital for Children, Indiana University, Indianapolis, Indiana, United States
,
Andrew L. Beardsley
1   Division of Pediatric Critical Care, Riley Hospital for Children, Indiana University, Indianapolis, Indiana, United States
,
Brian D. Leland
1   Division of Pediatric Critical Care, Riley Hospital for Children, Indiana University, Indianapolis, Indiana, United States
,
Elizabeth A. Moser
2   Department of Biostatistics, Indiana University, Indianapolis, Indiana, United States
,
Riad L. Lutfi 
1   Division of Pediatric Critical Care, Riley Hospital for Children, Indiana University, Indianapolis, Indiana, United States
,
A. Ioana Cristea
3   Division of Pediatric Pulmonology, Riley Hospital for Children, Indiana University, Indianapolis, Indiana, United States
,
Courtney M. Rowan 
1   Division of Pediatric Critical Care, Riley Hospital for Children, Indiana University, Indianapolis, Indiana, United States
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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

Authors' Contributions

C.M.R. conceptualized and designed the study, coordinated and supervised data collection, interpretation and analysis, and approved the final manuscript as submitted. A.K.B. conceptualized and designed the study, collected the data, drafted the initial manuscript, and approved the final manuscript as submitted.


A.L.B., B.D.L., R.L.L., and A.I.C. conceptualized and designed the study, supervised data collection, and approved the final manuscript as submitted. E.A.M. performed the initial analyses, reviewed and revised the manuscript, and approved the final manuscript as submitted.


Supplementary Material



Publication History

Received: 03 March 2021

Accepted: 14 May 2021

Article published online:
01 July 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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