Noninvasive positive pressure ventilation: Five years of experience in a pediatric intensive care unit*

Abstract

Objectives: 

To evaluate the feasibility and outcome of noninvasive positive pressure ventilation (NPPV) in daily clinical practice.

Design: 

Observational retrospective cohort study.

Setting: 

Pediatric intensive care unit in a university hospital.

Patients: 

Patients treated by NPPV, regardless of the indication, during five consecutive years (2000–2004).

Measurements and Results: 

A total of 114 patients were included, and 83 of the 114 patients (77%) were successfully treated by NPPV without intubation (NPPV success group). The success rate of NPPV was significantly lower (22%) in the patients with acute respiratory distress syndrome (p < .05) than in the other patients. The Pediatric Risk of Mortality II (p = .003) and Pediatric Logistic Organ Dysfunction scores (p = .002) at admission were significantly higher in patients who were unsuccessfully treated with NPPV (NPPV failure group). Baseline values of Pco₂, pulse oximetry, and respiratory rate did not differ between the two groups. A significant decrease in Pco₂ and respiratory rate within the first 2 hrs of NPPV was observed in the NPPV success group. Multivariate analysis showed that a diagnosis of acute respiratory distress syndrome (odds ratio, 76.8; 95% confidence interval, 4.4–1342; p = .003) and a high Pediatric Logistic Organ Dysfunction score (odds ratio, 1.09; 95% confidence interval, 1.01–1.17; p = .01) were independent predictive factors for NPPV failure. A total of 11 patients (9.6%), all belonging to the NPPV failure group, died during the study.

Conclusions: 

This study demonstrates the feasibility and efficacy of NPPV in the daily practice of a pediatric intensive care unit. This ventilatory support could be proposed as a first-line treatment in children with acute respiratory distress, except in those with a diagnosis of acute respiratory distress syndrome.