Clinical outcomes according to timing to invasive ventilation due to noninvasive ventilation failure in children

Abstract

Objective: Noninvasive ventilation (NIV) failure it has been associated to worst clinical outcomes due to a delay in intubation and initiation of invasive mechanical ventilation (IMV). There is a lack of evidence in pediatric patients regarding this topic. The objective was to deter-mine the association between duration of IMV and length of stay, with duration of NIV prior tointubation/IMV in pediatric patients.

Design: A prospective cohort study since January 2015 to October 2019.

Setting: A pediatric intensive care unit.

Patients: Children under 15 years with acute respiratory failure who failed to noninvasive ventilation.

Interventions: None.

Main variables of interest: Demographic variables, pediatric index of mortality (PIM2), pediatric acute respiratory distress syndrome (PARDS) diagnosis, IMV and NIV duration, PICU LOS were registered and intrahospital mortality.

Results: A total of 109 patients with a median (IQR) age of 7 (3-14) months were included. The main diagnosis was pneumonia (89.9%). PARDS was diagnosed in 37.6% of the sample. No association was found between NIV duration and duration of IMV after Kaplan-Meier analysis (Log rank P = .479). There was no significant difference between PICU LOS (P = .253) or hospital LOS (P = 0.669), when categorized by NIV duration before intubation. PARDS diagnosis was associated to an increased length of invasive ventilation (HR: 0.64 [95% IC: 0.42-0.99]).

Conclusions: No association was found between NIV duration prior to intubation and duration of invasive ventilation in critical pediatric patients with acute respiratory failure.

Keywords: Acute respiratory distress syndrome; Acute respiratory infection; Acute respiratory insufficiency; Infección respiratoria aguda; Insuficiencia respiratoria aguda; Mechanical ventilation; Noninvasive ventilation; Pediatrics; Pediatría; Síndrome de distrés respiratorio agudo; Ventilación mecánica; Ventilación no invasiva.