A prospective, randomized, controlled trial of noninvasive ventilation in pediatric acute respiratory failure.

  • Yanez L
  • Yunge M
  • Emilfork M
 et al. 
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OUTCOMES: To compare the benefits of noninvasive ventilation (NIV) plus standard therapy vs. standard therapy alone in children with acute respiratory failure; assess method effectiveness in improving gas exchange and vital signs; and assess method safety. DESIGN: Prospective, randomized, controlled study. SITE: Two pediatric intensive care units in Santiago, Chile, at Clinica Santa Maria and Clinica Davila, respectively. PATIENTS AND METHODS: Fifty patients with acute respiratory failure admitted to pediatric intensive care units were recruited; 25 patients were randomly allocated to noninvasive inspiratory positive airway pressure and expiratory positive airway pressure plus standard therapy (study group); the remaining 25 were given standard therapy (control group). Both groups were comparable in demographic terms. INTERVENTIONS AND MEASUREMENTS: The study group received NIV under inspiratory positive airway pressure ranging between 12 cm and 18 cm H2O and expiratory positive airway pressure between 6 cm and 12 cm H2O. Vital signs (cardiac and respiratory frequency), Po2, Pco2, pH, and Po2/Fio2 were recorded at the start and 1, 6, 12, 24, and 48 hrs into the study. RESULTS: Heart rate and respiratory rate improved significantly with NIV. Heart rate and respiratory rate were significantly lower after 1 hr of treatment compared with admission (p = 0.0009 and p = 0.004, respectively). The trend continued over time, heart rate being significantly lower than control after the first hour and heart rate after 6 hrs. With NIV, Po2/Fio2 improved significantly from the first hour. The endotracheal intubation was significantly lower (28%) in the NIV group than in the control group (60%; p = 0.045). CONCLUSIONS: NIV improves hypoxemia and the signs and symptoms of acute respiratory failure. NIV seems to afford these patients protection from endotracheal intubation.

Author-supplied keywords

  • Adolescent
  • Child
  • Child, Preschool
  • Chile
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Intensive Care Units, Pediatric
  • Male
  • Prospective Studies
  • Respiratory Distress Syndrome, Adult
  • Ventilation
  • methods
  • physiopathology
  • therapy

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  • Leticia J Yanez

  • Mauricio Yunge

  • Marcos Emilfork

  • Michelangelo Lapadula

  • Alex Alcantara

  • Carlos Fernandez

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