PMID- 35701174
OWN - NLM
STAT- MEDLINE
DCOM- 20220728
LR  - 20230322
IS  - 1943-3654 (Electronic)
IS  - 0020-1324 (Linking)
VI  - 67
IP  - 8
DP  - 2022 Aug
TI  - Clinical Outcomes of Acute Respiratory Failure Associated With Noninvasive and 
      Invasive Ventilation in a Pediatric ICU.
PG  - 956-966
LID - 10.4187/respcare.09348 [doi]
AB  - BACKGROUND: It remains unknown if pediatric patients failing initial noninvasive 
      ventilation (NIV) experience worse clinical outcomes than those successfully 
      treated with NIV or those primarily intubated. METHODS: This was a single-center, 
      retrospective review of patients admitted with acute respiratory failure to the 
      University of Michigan pediatric intensive care or cardiothoracic ICUs and 
      receiving NIV or invasive mechanical ventilation as first-line therapy. RESULTS: 
      One hundred seventy subjects met inclusion criteria and were enrolled: 65 NIV 
      success, 55 NIV failure, and 50 invasive mechanical ventilation alone. Of those 
      failing NIV, median time to intubation was 1.8 (interquartile range [IQR] < 1-7) 
      h. On multivariable regression, ICU-free days were significantly different 
      between groups (NIV success: 22.9 +/- 6.9 d; NIV failure: 13.0 +/- 6.6 d; invasive 
      ventilation: 12.5 +/- 6.9 d; P < .001 across all groups). Multivariable regression 
      revealed no difference in ventilator-free days between NIV failure and invasive 
      ventilation groups (15.4 +/- 10.1 d vs 15.9 +/- 9.7 d, P = .71). Of 64 subjects 
      (37.6%) meeting Pediatric Acute Lung Injury Consensus Conference pediatric ARDS 
      criteria, only 14% were successfully treated with NIV. Ventilator-free days were 
      similar between the NIV failure and invasive ventilation groups (11.6 vs 13.2 d, 
      P = .47). On multivariable analysis, ICU-free days were significantly different 
      across pediatric ARDS groups (P < .001): NIV success: 20.8 + 31.7 d; NIV failure: 
      8.3 + 23.8 d; invasive alone: 8.9 + 23.9 d, yet no significant difference in 
      ventilator-free days between those with NIV failure versus invasive alone (11.6 
      vs 13.2 d, P = .47). CONCLUSIONS: We demonstrated that critically ill pediatric 
      subjects unsuccessfully trialed on NIV did not experience increased ICU length of 
      stay or fewer ventilator-free days when compared to those on invasive mechanical 
      ventilation alone, including in the pediatric ARDS subgroup. Our findings are 
      predicated on a median time to intubation of < 2 h in the NIV failure group and 
      the provision of adequate monitoring while on NIV.
CI  - Copyright (c) 2022 by Daedalus Enterprises.
FAU - Kyle, James M
AU  - Kyle JM
AD  - Department of Pediatrics, Division of Pediatric Critical Care and Sedation 
      Services, Tripler Army Medical Center, Honolulu, Hawaii.
FAU - Sturza, Julie M
AU  - Sturza JM
AD  - Department of Pediatrics, University of Michigan, C.S. Mott Children's Hospital, 
      Ann Arbor, Michigan.
FAU - Dechert, Ronald E
AU  - Dechert RE
AD  - Pediatric Respiratory Care, University of Michigan, Ann Arbor, Michigan.
FAU - Custer, Joseph R
AU  - Custer JR
AD  - Division of Pediatric Critical Care Medicine, Department of Pediatrics, 
      University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, Michigan.
FAU - Dahmer, Mary K
AU  - Dahmer MK
AD  - Division of Pediatric Critical Care Medicine, Department of Pediatrics, 
      University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, Michigan.
FAU - Saba, Thomas G
AU  - Saba TG
AD  - Division of Pediatric Pulmonology, Department of Pediatrics, University of 
      Michigan, C.S Mott Children's Hospital, Ann Arbor, Michigan.
FAU - Flori, Heidi R
AU  - Flori HR
AD  - Division of Pediatric Critical Care Medicine, Department of Pediatrics, 
      University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, Michigan. 
      heidiflo@med.umich.edu.
LA  - eng
PT  - Journal Article
DEP - 20220614
PL  - United States
TA  - Respir Care
JT  - Respiratory care
JID - 7510357
SB  - IM
MH  - Child
MH  - Humans
MH  - Intensive Care Units
MH  - Intensive Care Units, Pediatric
MH  - *Noninvasive Ventilation
MH  - Respiration, Artificial
MH  - *Respiratory Distress Syndrome/therapy
MH  - *Respiratory Insufficiency/etiology/therapy
OTO - NOTNLM
OT  - acute respiratory failure
OT  - clinical outcomes
OT  - mechanical ventilation
OT  - noninvasive ventilation
OT  - pediatric
OT  - pediatric ARDS
OT  - positive pressure ventilation
COIS- The authors have disclosed no conflicts of interest.
EDAT- 2022/06/15 06:00
MHDA- 2022/07/29 06:00
CRDT- 2022/06/14 21:43
PHST- 2022/06/15 06:00 [pubmed]
PHST- 2022/07/29 06:00 [medline]
PHST- 2022/06/14 21:43 [entrez]
AID - respcare.09348 [pii]
AID - 10.4187/respcare.09348 [doi]
PST - ppublish
SO  - Respir Care. 2022 Aug;67(8):956-966. doi: 10.4187/respcare.09348. Epub 2022 Jun 
      14.