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Multicenter Study
. 2021 May;56(5):1237-1244.
doi: 10.1002/ppul.25246. Epub 2021 Jan 11.

Early factors related to mortality in children treated with bi-level noninvasive ventilation and CPAP

Jorge López  1   2   3   4 , Martí Pons-Òdena  5   6 , Alberto Medina  7 , Cristina Molinos-Norniella  8 , Daniel Palanca-Arias  9 , Demet Demirkol  10 , José S León-González  11 , Yolanda M López-Fernández  12 , Luis Perez-Baena  11 , Jesús López-Herce  1   2   3   4 ; NIV Research Group
Affiliations
Multicenter Study

Early factors related to mortality in children treated with bi-level noninvasive ventilation and CPAP

Jorge López et al. Pediatr Pulmonol. 2021 May.

Abstract

Objective: To describe and analyze the characteristics and the early risk factors for mortality of noninvasive ventilation (NIV) in critically ill children.

Study design: A multicenter, prospective, observational 2-year study carried out with critically ill patients (1 month - 18 years of age) who needed NIV. Clinical data and NIV parameters during the first 12 h of admission were collected. A multilevel mixed-effects logistic regression was performed to identify mortality risk factors.

Results: A total of 781 patients (44.2 ± 57.7 months) were studied (57.8% male). Of them, 53.7% had an underlying condition, and 47.1% needed NIV for lower airway respiratory pathologies. Bi-level NIV was the initial support in 78.2% of the patients. Continuous positive airway pressure (CPAP) was used more in younger patients (33.7%) than in older ones (9.7%; p < .001). About 16.7% had to be intubated and 6.2% died. The risk factors for mortality were immunodeficiency (odds ratio [OR] = 11.79; 95% confidence interval [CI] = 2.95-47.13); cerebral palsy (OR = 5.86; 95% CI = 1.94-17.65); presence of apneas on admission (OR = 5.57; 95% CI = 2.13-14.58); tachypnea 6 h after NIV onset (OR = 2.59; 95% CI = 1.30-6.94); and NIV failure (OR = 6.54; 95% CI = 2.79-15.34).

Conclusion: NIV is used with great variability in types of support. Younger children receive CPAP more frequently than older children. Immunodeficiency, cerebral palsy, apneas on admission, tachypnea 6 h after NIV onset, and NIV failure are the early factors associated with mortality.

Keywords: bi-level continuous positive airway pressure; complications; pediatric intensive care units; respiratory failure.

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References

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