Elsevier

Journal of Critical Care

Volume 32, April 2016, Pages 175-181
Journal of Critical Care

Clinical Potpourri
Efficacy of noninvasive mechanical ventilation in prevention of intubation and reintubation in the pediatric intensive care unit

https://doi.org/10.1016/j.jcrc.2015.12.013Get rights and content

Abstract

Purpose

To determine the efficiency of noninvasive mechanical ventilation (NIV) both in protection from intubation and in preventing reintubation of postextubation in patients in the pediatric intensive care unit (PICU).

Methods

A prospective observational study was conducted in a multidisciplinary 10-bed tertiary PICU of a university hospital. All patients were admitted to our unit from June 2012 to May 2014 and deemed to be candidates to receive continuous positive airway pressure or bilevel positive airway pressure.

Measurements and Results

We performed 160 NIV episodes in 137 patients. Their median age was 9 months (range, 1-240 months), and their median weight was 7.5 kg (range, 2.5-65 kg). Fifty-seven percent of patients were male. Noninvasive mechanical ventilation was successful in 70% (112 episodes) of patients. There was an underlying illness in 83.8% (134 episodes) of the patients. Bilevel positive airway pressure support was given to 57.5% (92 episodes) of the patients, whereas the remaining 42.5% (68 episodes) received continuous positive airway pressure support. Among the causes of respiratory failure in our patients, the most frequent were postextubation, pneumonia, bronchiolitis, atelectasia, and cardiogenic pulmonary edema. Sedation was applied in 43.1% of the episodes. Complications were detected in 29 episodes (18.1 %). The NIV failure group showed higher Pediatric Risk of Mortality III-24 score, shorter NIV duration, more frequent underlying disease, lower number fed, longer length of PICU stay, and hospital stay, and mortality was higher.

Conclusions

Noninvasive mechanical ventilation effectively and reliably reduced endotracheal intubation in the treatment of respiratory failure due to different clinical situations. Our results suggest that NIV can play an important role in PICUs in helping to avoid intubation and prevent reintubation. Although there were serious underlying diseases in most of our patients, such as immunosuppression, 70% avoided intubation with use of NIV.

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.

References (34)

  • A. Esteban et al.

    Effect of spontaneous breathing trial duration on outcome of attempts to discontinue mechanical ventilation. Spanish Lung Failure Collaborative Group

    Am J Respir Crit Care Med

    (1999)
  • S. Nava et al.

    Time of non-invasive ventilation

    Intensive Care Med

    (2006)
  • A. Yaman et al.

    Successful noninvasive mechanical ventilation in a child on prolonged and life-threatening invasive mechanical ventilation after Fontan operation

    Turk J Pediatr

    (2014)
  • W.G. Teague

    Noninvasive ventilation in the pediatric intensive care unit for children with acute respiratory failure

    Pediatr Pulmonol

    (2003)
  • R. Soto et al.

    Ventilación no invasive en pacientes con daño pulmonar agudo

    Rev Chil Enf Respir

    (2008)
  • S. Essouri et al.

    Noninvasive positive pressure ventilation: five years experience in a pediatric intensive care unit

    Pediatr Crit Care Med

    (2006)
  • J. Mayordomo-Colunga et al.

    Predictive factors of non invasive ventilation failure in critically ill children: a prospective epidemiological study

    Intensive Care Med

    (2009)
  • Cited by (42)

    • Weaning from ventilation and extubation of children in critical care

      2022, BJA Education
      Citation Excerpt :

      Studies have shown that NIV is a safe therapy. Complication rates have been found to be about 18% and include, mostly, mild discomfort, superficial skin lesions, and, rarely, skin necrosis, pneumothorax and aspiration.24–26 The rate of extubation failure in the PICU ranges from 2.7% to 30% and usually occurs within 24–96 h after extubation.1,3,7,8,27

    • Hydrocolloid versus silicone gel for the prevention of nasal injury in newborns submitted to noninvasive ventilation: A randomized clinical trial

      2020, Heliyon
      Citation Excerpt :

      The NIV provides ventilatory support through a noninvasive (external) interface, replacing the invasive mechanical ventilation and their deleterious effects [1, 2, 3].

    View all citing articles on Scopus
    View full text