Clinical PotpourriEfficacy of noninvasive mechanical ventilation in prevention of intubation and reintubation in the pediatric intensive care unit
Introduction
Acute respiratory failure (ARF) is one of the most frequent causes of admission to the pediatric intensive care unit (PICU). Conventional management of ARF in adult and pediatric intensive care patients consists of endotracheal intubation and mechanical ventilation, with their associated risks and adverse effects, such as the need for heavy sedation, infections, ventilator-associated pneumonia, ventilator-induced lung injury, and laryngeal-tracheal damage [1], [2].
Noninvasive mechanical ventilation (NIV) is an alternative form of respiratory treatment that includes various techniques for improving alveolar ventilation, oxygenation, and unloading of respiratory muscles without the need for an endotracheal airway. Noninvasive mechanical ventilation is used to treat acute and chronic respiratory failure in infants and children [3]. Noninvasive mechanical ventilation is primarily used to avoid the need for endotracheal intubation in patients with early-stage ARF and postextubation respiratory failure. Unsuccessful extubation has been noted to be associated with an increase in both morbidity and mortality in adult and pediatric patients [4], [5], [6], [7]. It can also be used as an alternative to invasive ventilation at a more advanced stage of ARF or to facilitate the process of weaning from mechanical ventilation [8], [9].
The aim of this study was to determine the efficiency of NIV both in prevention of intubation and in preventing reintubation of postextubation as a first-line treatment in the PICU. We report here our experience with the use of NIV in patients who were admitted to our PICU for 2 consecutive years.
Section snippets
Setting and patients
This prospective observational study was conducted in a multidisciplinary 10-bed tertiary PICU of a university hospital. Our PICU is a unit that follow up medical and postoperative surgical patients. Approximately 300 to 350 patients are annually admitted to our unit. In our unit, pediatric intensive care sub-branch training is given. In our unit, there is 1 nurse for every 3 patients. All patients were admitted to our unit from June 2012 to May 2014 and were deemed to be candidates to receive
Patients
During the study period, the total number of NIV episodes included was 160, in 137 patients. Noninvasive mechanical ventilation support was given 5 times to 1 patient, 4 times to 2 patients, 3 times to 3 patients, and twice to 17 patients. The median age was 9 months (range, 1-240 months), and the median weight was 7.5 kg (range, 2.5-65 kg). The proportion of male patients was 57.5%. The proportion of patients who were younger than 1 year was 54.4% (87 episodes); 1 to 5 years, 26.9% (43
Discussion
Noninvasive support has been well studied in neonatal and adult respiratory failure, but a definitive randomized trial has not been performed in children. We have increasingly used NIV in various respiratory conditions. During the study period, the total number of NIV episodes was 160, in 137 patients. To our knowlodge, this is the largest prospective observational study of a pediatric population treated with NIV in a single center. The overall success rate was 70%. Previous studies showed
Conclusions
In recent years, NIV has safely and effectively improved the respiratory status and reduced endotracheal intubation in pediatric patients with ARF of various etiologies. Although most of our patients had a serious underlying disease, through NIV, 70% of them were prevented from intubation. Our results suggest that NIV can play an important role in the PICU in helping to avoid intubation and prevent reintubation. The failure group showed higher PRISM III-24 score, longer length of PICU stay and
Conflict of interest
The authors declare that they have no conflicts of interest in the research.
Authors' contributions
A.Y. collected data, figures, and drafted the manuscript. T.K. commented on and revised the final manuscript. Ç.Ö. revised the manuscript. C.A. did the data analysis. N.T. collected data. M.G. collected data. E.İ. commented on and revised the final manuscript.
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