Baker Alyson K, Beardsley Andrew L, Leland Brian D, Moser Elizabeth A, Lutfi Riad L, Cristea A Ioana, Rowan Courtney M
Division of Pediatric Critical Care, Riley Hospital for Children, Indiana University, Indianapolis, Indiana, United States.
Department of Biostatistics, Indiana University, Indianapolis, Indiana, United States.
J Pediatr Intensive Care. 2021 Jul 1;12(3):196-202. doi: 10.1055/s-0041-1731433. eCollection 2023 Sep.
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 ( = 0.01) and pediatric logistic organ dysfunction ( = 0.002) scores and higher fraction of inspired oxygen (FiO ; = 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% ( = 0.06). Multivariable Cox's proportional hazard models revealed FiO 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], < 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.
无创通气（NIV）是治疗急性呼吸衰竭的常用方法。指导其应用的大多数数据是从成人研究中推断出来的。我们试图确定与NIV失败相关的临床预测因素，NIV失败定义为需要插管。这项单中心回顾性观察研究纳入了2014年7月至2016年6月在儿科重症监护病房（PICU）接受NIV治疗的儿童，不包括拔管后患者。共纳入148例患者。27例（18%）NIV治疗失败。两组在年龄、性别、合并症或急性呼吸衰竭病因方面无差异。治疗失败的患者入院时儿童死亡风险（ = 0.01）和儿童逻辑器官功能障碍（ = 0.002）评分更高，NIV开始时吸入氧分数（FiO ； = 0.009）更高。治疗失败与呼吸急促无改善有关。在NIV治疗6小时时，失败组呼吸急促加重，呼吸频率中位数增加8%，而成功组呼吸频率中位数降低18%（ = 0.06）。多变量Cox比例风险模型显示，开始时的FiO 以及1小时和6小时时呼吸频率恶化是NIV失败的显著风险因素。治疗失败与PICU住院时间显著延长有关（成功组[2.8天四分位数间距（IQR）：1.7，5.5]与失败组[10.6天IQR：5.6，13.2]， < 0.001）。NIV可成功用于治疗儿科患者的急性呼吸衰竭。对于呼吸急促对NIV无反应的低氧血症患者，应高度关注NIV失败情况。应密切监测是否有改善趋势。
