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

Yañez, Leticia J. MD; Yunge, Mauricio MD; Emilfork, Marcos MD; Lapadula, Michelangelo MD; Alcántara, Alex MD; Fernández, Carlos MD; Lozano, Jaime MD; Contreras, Mariana MD; Conto, Luis MD; Arevalo, Carlos MD; Gayan, Alejandro MD; Hernández, Flora RN; Pedraza, Mariela MD; Feddersen, Marion MD; Bejares, Marcela MD; Morales, Marta MD; Mallea, Fernando MD; Glasinovic, Maritza MD; Cavada, Gabriel PhD

Pediatric Critical Care Medicine: September 2008 - Volume 9 - Issue 5 - p 484-489
doi: 10.1097/PCC.0b013e318184989f
Continuing Medical Education Article

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 Clínica Santa María and Clínica Dávila, 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. (Pediatr Crit Care Med 2008; 9:484–489)

Associate Professor (LY, MY, ME), University of Los Andes, Director of Pediatric Intensive Care Unit, Santa Maria Clinic, Los Andes, Argentina; Associate Professor (ML, AA, CF, JL), University of Los Andes, Pediatric Intensivist, Pediatric Intensive Care Unit, Santa Maria Clinic, Los Andes, Argentina; Pediatric Intensivist (MC), Pediatric Intensive Care Unit, Santa Maria Clinic, Los Andes, Argentina; Pediatric Intensivist (FM, MM, MB, MF, MP, MG, FH, AG, CA, LC), Pediatric Intensive Care Unit, Davila Clinic, Santiago, Chile; Biostastician (GC), School of Public Health, Unversity of Chile, Santiago, Chile.

The authors have not disclosed any potential conflicts of interest.

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©2008The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies