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Observational Study
. 2024 Jul 11;28(1):235.
doi: 10.1186/s13054-024-04976-2.

Implications of sedation during the use of noninvasive ventilation in children with acute respiratory failure (SEDANIV Study)

Lorena Bermúdez-Barrezueta #  1   2 , Juan Mayordomo-Colunga #  3   4   5   6   7 , María Miñambres-Rodríguez  8 , Susana Reyes  8 , Juan Valencia-Ramos  9   10 , Yolanda Margarita Lopez-Fernandez  11 , Mikel Mendizábal-Diez  12 , Ana Vivanco-Allende  3   7 , Alba Palacios-Cuesta  13 , Lidia Oviedo-Melgares  13 , José Luis Unzueta-Roch  14 , Jorge López-González  15 , María Teresa Jiménez-Villalta  16 , Maite Cuervas-Mons Tejedor  9 , Lourdes Artacho González  17 , Ainhoa Jiménez Olmos  18 , Martí Pons-Òdena  19   20 ; SEDANIV Study group of the Spanish Society of Pediatric Intensive Care
Collaborators, Affiliations
Observational Study

Implications of sedation during the use of noninvasive ventilation in children with acute respiratory failure (SEDANIV Study)

Lorena Bermúdez-Barrezueta et al. Crit Care. .

Abstract

Background: The objective of this study was to analyze the effects of sedation administration on clinical parameters, comfort status, intubation requirements, and the pediatric intensive care unit (PICU) length of stay (LOS) in children with acute respiratory failure (ARF) receiving noninvasive ventilation (NIV).

Methods: Thirteen PICUs in Spain participated in a prospective, multicenter, observational trial from January to December 2021. Children with ARF under the age of five who were receiving NIV were included. Clinical information and comfort levels were documented at the time of NIV initiation, as well as at 3, 6, 12, 24, and 48 h. The COMFORT-behavior (COMFORT-B) scale was used to assess the patients' level of comfort. NIV failure was considered to be a requirement for endotracheal intubation.

Results: A total of 457 patients were included, with a median age of 3.3 months (IQR 1.3-16.1). Two hundred and thirteen children (46.6%) received sedation (sedation group); these patients had a higher heart rate, higher COMFORT-B score, and lower SpO2/FiO2 ratio than did those who did not receive sedation (non-sedation group). A significantly greater improvement in the COMFORT-B score at 3, 6, 12, and 24 h, heart rate at 6 and 12 h, and SpO2/FiO2 ratio at 6 h was observed in the sedation group. Overall, the NIV success rate was 95.6%-intubation was required in 6.1% of the sedation group and in 2.9% of the other group (p = 0.092). Multivariate analysis revealed that the PRISM III score at NIV initiation (OR 1.408; 95% CI 1.230-1.611) and respiratory rate at 3 h (OR 1.043; 95% CI 1.009-1.079) were found to be independent predictors of NIV failure. The PICU LOS was correlated with weight, PRISM III score, respiratory rate at 12 h, SpO2 at 3 h, FiO2 at 12 h, NIV failure and NIV duration. Sedation use was not found to be independently related to NIV failure or to the PICU LOS.

Conclusions: Sedation use may be useful in children with ARF treated with NIV, as it seems to improve clinical parameters and comfort status but may not increase the NIV failure rate or PICU LOS, even though sedated children were more severe at technique initiation in the present sample.

Keywords: Acute respiratory failure; Comfort; Noninvasive ventilation; Sedation.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the study population. NIV, noninvasive ventilation
Fig. 2
Fig. 2
The data were collected at 0, 3, 6, 12, 24 and 48 h after NIV initiation according to sedation status. The mean and 95% confidence intervals are shown. A Heart rate. B Respiratory rate. C Comfort-B scale. (D) SpO2/FiO2 (S/F) ratio. (E) Modified Wood’s clinical asthma score. ªSpO2 over 97% was excluded from the calculation of the S/F ratio. *p < 0.05 for between-group comparisons
See this image and copyright information in PMC

References

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