Klin Padiatr 2015; 227(06/07): 322-328
DOI: 10.1055/s-0034-1395692
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

The Cause of Acute Respiratory Failure Predicts the Outcome of Noninvasive Ventilation in Immunocompromised Children

Die Ursache des Akuten Atemversagens sagt den Outcome von Nichtinvasiver Beatmung bei Kindern mit Immunsuppression vorher
H. Fuchs
1   Department of Neonatology and Pediatric Critical Care, Center for Pediatrics, Freiburg, Germany
,
J. Schoss
2   Division of Neonatology and Pediatric Critical Care, University Medical Center Ulm, Germany
,
M. R. Mendler
2   Division of Neonatology and Pediatric Critical Care, University Medical Center Ulm, Germany
,
W. Lindner
2   Division of Neonatology and Pediatric Critical Care, University Medical Center Ulm, Germany
,
R. Hopfner
2   Division of Neonatology and Pediatric Critical Care, University Medical Center Ulm, Germany
,
A. Schulz
3   Department of Oncology and Stem Cell Transplantation, University Medical Center Ulm, Germany
,
M. Hoenig
3   Department of Oncology and Stem Cell Transplantation, University Medical Center Ulm, Germany
,
D. Steinbach
3   Department of Oncology and Stem Cell Transplantation, University Medical Center Ulm, Germany
,
K.-M. Debatin
3   Department of Oncology and Stem Cell Transplantation, University Medical Center Ulm, Germany
,
H. D. Hummler
2   Division of Neonatology and Pediatric Critical Care, University Medical Center Ulm, Germany
,
M. Schmid
2   Division of Neonatology and Pediatric Critical Care, University Medical Center Ulm, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
04 February 2015 (online)

Abstract

Background: Noninvasive ventilation (NIV) may be superior to conventional therapy in immunocompromised children with respiratory failure.

Methods: Mortality, success rate, prognostic factors and side effects of NIV for acute respiratory failure (ARF) were investigated retrospectively in 41 in children with primary immunodeficiency, after stem cell transplantation or chemotherapy for oncologic disease.

Results: In 11/41 (27%) children invasive ventilation was avoided and patients were discharged from ICU. In children with NIV failure ICU-mortality was 19/30 (63%). 8/11 (72%) children with NIV success had recurrence of ARF after 27 days. Only 4/11 (36%) children with first episode NIV success and 8/30 (27%) with NIV failure survived to hospital discharge. Lower FiO2, SpO2/FiO2 and blood culture positive bacterial sepsis were predictive for NIV success, while fungal sepsis or culture negative ARF were predictive for NIV failure. We observed catecholamine treatment in 14/41 (34%), pneumothorax in 2/41 (5%), mediastinal emphysema in 3/41 (7%), a life threatening nasopharyngeal hemorrhage and need for resuscitation during intubation in 5/41 (12%) NIV-episodes.

Conclusions: The prognosis of ARF in immunocompromised children remains guarded independent of initial success or failure of NIV due to a high rate of recurrent ARF. Reversible causes like bacterial sepsis had a higher NIV response rate. Relevant side effects of NIV were observed.

Zusammenfassung

Hintergrund: Nichtinvasive Beatmung könnte gegenüber konventioneller Therapie eine Vorteil bei der Behandlung des Atemversagens bei immunsupprimierten Kindern haben.

Methoden: Mortalität, Erfolgsrate, prognostische Faktoren und Nebenwirkungen von nichtinvasiver Beatmung (NIV) beim akuten Atemversagen (ARF) wurden retrospektiv in einer Kohorte von 41 Kindern mit primärem Immundefekt, nach onkologischer Therapie oder nach Stammzelltransplantation untersucht.

Ergebnisse: Bei 11/41 (27%) konnte die Intubation vermieden werden und die Kinder wurden von der Intensivstation entlassen. Die Intensivmortalität der Kinder mit NIV-Versagen betrug 19/30 (63%). 8/11 (72%) Kinder mit NIV-Erfolg wurden nach im Median 27 Tagen mit erneutem Atemversagen auf die Intensivstation wiederaufgenommen und benötigten erneut NIV. Nur 4/11 (36%) Kinder mit NIV-Erfolg in der ersten Episode und 8/30 (27%) Kinder mit NIV-Versagen überlebten bis zur Krankenhausentlassung. Niedrigerer FiO2, SpO2/FiO2 und blutkultur-positive bakterielle Sepsis waren mit NIV-Erfolg, während Pilzinfektionen oder kultur-negatives Atemversagen mit NIV-Versagen assoziiert waren. Als Nebenwirkungen wurden Katecholaminbedarf in 14/41 (34%), Pneumothorax in 2/41 (5%), Mediastinalemphysem in 3/41 (7%), und Notwendigkeit zur Reanimation im Rahmen der Intubation bei 5/41 (12%) der NIV-Episoden beobachtet.

Schlussfolgerung: Die Prognose des ARF bei immunsupprimierten Kindern ist eingeschränkt, unabhängig vom initialen Erfolg oder Versagen der NIV aufgrund der hohen Rate an Rezidiven des Atemversagens. Behandelbare Ursachen des Atemversagens wie bakterielle Sepsis hatten eine höhere Rate an NIV-Erfolg. Relevante Nebenwirkungen der NIV müssen beachtet werden.

 
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