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. 2021 May 27:11:653607.
doi: 10.3389/fonc.2021.653607. eCollection 2021.

Risk Factors for Noninvasive Ventilation Failure in Children Post-Hematopoietic Cell Transplant

Courtney M Rowan  1 , Julie C Fitzgerald  2 , Asya Agulnik  3 , Matt S Zinter  4 , Matthew P Sharron  5 , James E Slaven  6 , Erin M Kreml  7 , Rajinder P S Bajwa  8 , Kris M Mahadeo  9 , Jerelyn Moffet  10 , Keiko M Tarquinio  11 , Marie E Steiner  12
Affiliations

Risk Factors for Noninvasive Ventilation Failure in Children Post-Hematopoietic Cell Transplant

Courtney M Rowan et al. Front Oncol. .

Abstract

Rationale: Little is known on the use of noninvasive ventilation (NIPPV) in pediatric hematopoietic cell transplant (HCT) patients.

Objective: We sought to describe the landscape of NIPPV use and to identify risk factors for failure to inform future investigation or quality improvement.

Methods: This is a multicenter, retrospective observational cohort of 153 consecutive children post-HCT requiring NIPPV from 2010-2016.

Results: 97 (63%) failed NIPPV. Factors associated with failure on univariate analysis included: longer oxygen use prior to NIPPV (p=0.04), vasoactive agent use (p<0.001), and higher respiratory rate at multiple hours of NIPPV use (1hr p=0.02, 2hr p=0.04, 4hr p=0.008, 8hr p=0.002). Using respiratory rate at 4 hours a multivariable model was constructed. This model demonstrated high ability to discriminate NIPPV failure (AUC=0.794) with the following results: respiratory rate >40 at 4 hours [aOR=6.3 9(95% CI: 2.4, 16.4), p<0.001] and vasoactive use [aOR=4.9 (95% CI: 1.9, 13.1), p=0.001]. Of note, 11 patients had a cardiac arrest during intubation (11%) and 3 others arrested prior to intubation. These 14 patients were closer to HCT [14 days (IQR:4, 73) vs 54 (IQR:21,117), p<0.01] and there was a trend toward beginning NIPPV outside of the PICU and arrest during/prior to intubation (p=0.056).

Conclusions: In this cohort respiratory rate at 4 hours and vasoactive use are independent risk factors of NIPPV failure. An objective model to predict which children may benefit from a trial of NIPPV, may also inform the timing of both NIPPV initiation and uncomplicated intubation.

Keywords: cardiopulmonary resuscitation; hematopoietic (stem) cell transplantation (HCT); intubation; noninvasive (positive pressure) ventilation; respiratory insufficiency.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Survival assessed by NIPPV success or failure at PICU and hospital discharge. Those who failed NIPPV, represented by the solid dark gray bars had a poor PICU and hospital survival. Those who were successfully treated with NIPPV, represented by the diagonal black lines, had a high PICU survival but there was a decrease in hospital survival noted.
See this image and copyright information in PMC

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