Noninvasive Ventilation Is Interrupted Frequently and Mostly Used at Night in the Pediatric Intensive Care Unit

Abstract

Background: Noninvasive ventilation (NIV) is commonly used to support children with respiratory failure, but detailed patterns of real-world use are lacking. The aim of our study was to describe use patterns of NIV via electronic medical record (EMR) data.

Methods: We performed a retrospective electronic chart review in a tertiary care pediatric ICU in the United States. Subjects admitted to the pediatric ICU from 2014 to 2017 who were mechanically ventilated were included in the study.

Results: The median number of discrete device episodes, defined as a time on support without interruption, was 20 (interquartile range [IQR] 8-49) per subject. The median duration of bi-level positive airway pressure (BPAP) support prior to interruption was 6.3 h (IQR 2.4-10.4); the median duration of CPAP was 6 h (IQR 2.1-10.4). Interruptions to BPAP had a median duration of 6.3 h (IQR 2-15.5); interruptions to CPAP had a median duration of 8.6 h (IQR 2.2-16.8). Use of NIV followed a diurnal pattern, with 44% of BPAP and 42% of CPAP subjects initiating support between 7:00 pm and midnight, and 49% of BPAP and 46% of CPAP subjects stopping support between 5:00 am and 10:00 am.

Conclusions: NIV was frequently interrupted, and initiation and discontinuation of NIV follows a diurnal pattern. Use of EMR data collected for routine clinical care allowed the analysis of granular details of typical use patterns. Understanding NIV use patterns may be particularly important to understanding the burden of pediatric ICU bed utilization for nocturnal NIV. To our knowledge, this is the first study to examine in detail the use of pediatric NIV and to define diurnal use and frequent interruptions to support.

Keywords: child; electronic health records; intensive care; mechanical ventilation; noninvasive ventilation.

Fig. 1.

Flow diagram of data extraction and processing. RN = registered nurse; RT = respiratory therapist; MD = physician; Q12h = every 12 h; EMR = electronic medical record; QI = quality improvement.

Fig. 2.

Interruptions of noninvasive ventilation. CPAP is shown in panels A and C; BPAP is shown in panels B and D. The top panels present the duration on respiratory support without interruption, and the lower panels present the duration of interruptions.

Fig. 3.

Diurnal use of noninvasive ventilation (NIV). CPAP is shown in panels A and C; BPAP is shown in panels B and D. Time of day is shown on the x axis, with both 0 and 24 representing midnight. The y axis shows the number of occurrences of NIV being started or stopped that occurred during each hour of the day. Panels A and B show the time at which respiratory support was started; panels C and D show the time at which respiratory support was stopped or interrupted.

Fig. 4.

Graphical representation of a single subject's respiratory support over time.