Medicina Intensiva  (English Edition) Medicina Intensiva  (English Edition)
Original
Safety of aerosol therapy in children during noninvasive ventilation with helmet and total face mask
Seguridad de la aerosolterapia durante la ventilación mecánica no invasiva con helmet y mascarilla facial total en población pediátrica
L. Rodriguez Garciaa,, , A. Medinab,c, V. Modesto i Alapontd, M.L. Palacios Loroe, J. Mayordomo-Colungab,c, A. Vivanco-Allendeb, C. Reyf,g
a Paediatric Intensive Care Unit, Department of Paediatrics, Complejo Asistencial Universitario de León, León, Spain
b Paediatric Intensive Care Unit, Department of Paediatrics, Hospital Universitario Central de Asturias, Oviedo, Spain
c CIBERes
d Department of Anesthesiology and Critical Care, Hospital Universitari i Politècnic La Fe de Valencia, Valencia, Spain
e Department of Paediatrics, Hospital Universitario Central de Asturias, Oviedo, Spain
f Paediatric Intensive Care Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
g Universidad de Oviedo, Oviedo, Spain
Received 26 March 2018, Accepted 04 June 2018
Abstract
Purpose

To evaluate the consequences of using nebulized drugs in patients subjected to noninvasive ventilation (NIV) with total face mask (TFM) and helmet.

Design

A descriptive analytical study of a prospective patient cohort was carried out.

Ambit

Pediatric intensive care unit (PICU) of a tertiary hospital.

Patients

Consecutive sampling was used to include all patients admitted to the PICU and requiring NIV with helmet or TFM over a period of 29 months. No patients were excluded.

Interventions

Nebulized treatment was added according to medical criteria.

Variables of interest

Independent variables were age, sex, diagnosis, disease severity, ventilation parameters and nebulized drugs (if administered). Secondary outcomes were duration and failure of NIV, and length of PICU stay.

Results

The most frequent diagnoses were bronchiolitis (60.5%) and asthma (23%). Patients received NIV for a median of 43h. Nebulized drugs were administered in 40% of the cases during NIV, and no adverse effects were registered. Using Bayesian statistics, the calculated probability of suffering an adverse effect was 1.3% with helmet and 0.5% with TFM (high density 95% probability intervals). Patients with helmet and nebulized therapy were in more serious condition than those who did not receive nebulization; nevertheless, no differences were observed regarding the need to change to bilevel modality. With TFM, PICU stay was shorter for the same degree of severity (p=0.033), and the NIV failure rate was higher in patients who did not receive inhaled drugs (p=0.024).

Conclusions

The probability of suffering an adverse effect related to nebulization is extremely low when using a helmet or TFM. Inhaled therapy with TFM may shorten PICU stay in some patients.

Resumen
Objetivo

Evaluar las consecuencias de la medicación nebulizada en pacientes con ventilación no invasiva (VNI) con mascarilla facial total (MFT) y casco.

Diseño

Estudio analítico descriptivo sobre una cohorte prospectiva de pacientes.

Ámbito

UCIP de hospital de tercer nivel.

Pacientes

Todos los pacientes ingresados en UCIP (muestreo consecutivo) con VNI con casco o MFT durante 29 meses. No se excluyeron pacientes.

Intervenciones

Se añadió tratamiento nebulizado según criterio médico.

Variables de interés

Independientes: edad, sexo, diagnóstico, gravedad, parámetros ventilatorios y medicación nebulizada (si se utilizaba). Secundarias: duración, fallo de VNI y estancia en UCIP.

Resultados

Los diagnósticos más frecuentes fueron bronquiolitis (60,5%) y asma (23%). La mediana de conexión a VNI fue de 43 horas. Se administraron nebulizaciones durante la VNI en un 40% sin registrarse efectos adversos. La probabilidad calculada de tener un efecto adverso fue 1,3% con casco y 0,5% con MFT (estadística bayesiana, intervalo de probabilidad 95%). Los pacientes con casco y aerosolterapia tenían mayor gravedad que los que no recibieron nebulizaciones, sin encontrarse diferencias en la necesidad de cambiar a modalidad con doble nivel de presión. En los pacientes con MFT la estancia en UCIP fue menor (p=0,033) a pesar de no existir diferencias en el nivel de gravedad; la tasa de fallo de VNI fue mayor en los que no recibieron nebulizaciones (p=0,024).

Conclusiones

La probabilidad de tener un efecto adverso relacionado con la nebulización es baja utilizando casco o MFT. La terapia inhalada con MFT puede disminuir la estancia en UCIP en algunos pacientes.

Keywords
Noninvasive ventilation (NIV), Drug side effect, Bronchial spasm, Asthma, Bronchiolitis, Nebulizers and vaporizers, Total face mask, Helmet
Palabras clave
Ventilación no invasiva (VNI), Efectos secundarios, Broncoespasmo, Asma, Bronquiolitis, Nebulización, Mascarilla facial total, Casco

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