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

Abstract

Objective: Identification of predictive factors for non-invasive ventilation (NIV) failure and determination of NIV characteristics. Design: Prospective observational study. Setting: Paediatric Intensive Care Unit in a University Hospital. Patients and measurements: A total of 116 episodes were included. Clinical data collected were respiratory rate (RR), heart rate and FiO2 before NIV began. Same data and expiratory and support pressures were collected at 1, 6, 12, 24 and 48 h. Conditions precipitating acute respiratory failure (ARF) were classified into two groups: type 1 (38 episodes) and type 2 (78 episodes). Ventilation-perfusion impairment was the main respiratory failure mechanism in type 1, and hypoventilation in type 2. Factors predicting NIV failure were determined by multivariate analysis. Results: Most common admission diagnoses were pneumonia (81.6%) in type 1 and bronchiolitis (39.7%) and asthma (42.3%) in type 2. Complications secondary to NIV were detected in 23 episodes (20.2%). NIV success rate was 84.5% (68.4% in type 1 and 92.3% in type 2). Type 1 patients showed a higher risk of NIV failure compared to type 2 (OR 11.108; CI 95%, 2.578-47.863). A higher PRISM score (OR 1.138; CI 95%, 1.022-1.267), and a lower RR decrease at 1 h and at 6 h (OR 0.926; CI 95%, 0.860-0.997 and OR 0.911; CI 95%, 0.837-0.991, respectively) were also independently associated with NIV failure. Conclusions: NIV is a useful respiratory support technique in paediatric patients. Type 1 group classification, higher PRISM score, and lower RR decrease during NIV were independent risk factors for NIV failure.