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. 2023 Sep 1;24(9):715-726.
doi: 10.1097/PCC.0000000000003281. Epub 2023 May 31.

Noninvasive Ventilation for Pediatric Acute Respiratory Distress Syndrome: Experience From the 2016/2017 Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Prospective Cohort Study

Guillaume Emeriaud  1 , Marti Pons-Òdena  2   3 , Anoopindar K Bhalla  4   5 , Steven L Shein  6 , Elizabeth Y Killien  7 , Vicent Modesto I Alapont  8 , Courtney Rowan  9 , Florent Baudin  10 , John C Lin  11 , Gabrielle Grégoire  12 , Natalie Napolitano  13 , Juan Mayordomo-Colunga  1   2   3   4   5   6   7   8   9   10   11   12   13   14   15   16   17   18   19   20 , Franco Diaz  17   18 , Pablo Cruces  18   19 , Alberto Medina  14   15 , Lincoln Smith  20 , Robinder G Khemani  4   5 ; Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology (PARDIE) Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network
Collaborators, Affiliations

Noninvasive Ventilation for Pediatric Acute Respiratory Distress Syndrome: Experience From the 2016/2017 Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Prospective Cohort Study

Guillaume Emeriaud et al. Pediatr Crit Care Med. .

Abstract

Objectives: The worldwide practice and impact of noninvasive ventilation (NIV) in pediatric acute respiratory distress syndrome (PARDS) is unknown. We sought to describe NIV use and associated clinical outcomes in PARDS.

Design: Planned ancillary study to the 2016/2017 prospective Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology study.

Setting: One hundred five international PICUs.

Patients: Patients with newly diagnosed PARDS admitted during 10 study weeks.

Interventions: None.

Measurements and main results: Children were categorized by their respiratory support at PARDS diagnosis into NIV or invasive mechanical ventilation (IMV) groups. Of 708 subjects with PARDS, 160 patients (23%) received NIV at PARDS diagnosis (NIV group). NIV failure rate (defined as tracheal intubation or death) was 84 of 160 patients (53%). Higher nonrespiratory pediatric logistic organ dysfunction (PELOD-2) score, Pa o2 /F io2 was less than 100 at PARDS diagnosis, immunosuppression, and male sex were independently associated with NIV failure. NIV failure was 100% among patients with nonrespiratory PELOD-2 score greater than 2, Pa o2 /F io2 less than 100, and immunosuppression all present. Among patients with Pa o2 /F io2 greater than 100, children in the NIV group had shorter total duration of NIV and IMV, than the IMV at initial diagnosis group. We failed to identify associations between NIV use and PICU survival in a multivariable Cox regression analysis (hazard ratio 1.04 [95% CI, 0.61-1.80]) or mortality in a propensity score matched analysis ( p = 0.369).

Conclusions: Use of NIV at PARDS diagnosis was associated with shorter exposure to IMV in children with mild to moderate hypoxemia. Even though risk of NIV failure was high in some children, we failed to identify greater hazard of mortality in these patients.

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Conflict of interest statement

Dr. Emeriaud’s institution received funding from Fonds de recherche du Quebec Santé (research public agency award) and Maquet. Dr. Pons-Òdena’s institution received funding from Medtronic; he received funding from Philips Respironics. Drs. Bhalla and Killien received support for article research from the National Institutes of Health. Dr. Shein received funding from Hill Ward Henderson. Dr. Killien’s institution received funding from the National Institutes of Child Health and Human Development. Dr. Rowan’s institution received funding from the National Heart, Lung, and Blood Institute (K23). Dr. Lin received funding from ROMTech. Dr. Napolitano’s institution received funding from Drager, Actuated Medical, Philips/Respinronics, and VeroBiotech. Dr. Khemani received funding from Orange Med and Bayer. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Number of patients treated with non-invasive ventilation (NIV) at PARDS diagnosis and success rate, depending on the presence of a high non-respiratory PELOD-2 score, immunosuppression, severe hypoxemia (PaO2/FiO2 <100), a combination of these factors.
Figure 2.
Figure 2.
Proportion of NIV failure and mortality rate depending on initial SpO2/FiO2 ratio (upper panel) and PaO2/FiO2 ratio (lower panel).
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