, Volume 35, Issue 8, pp 1420-1427
Date: 23 Jun 2009

Noninvasive pressure-support ventilation in immunocompromised children with ARDS: a feasibility study

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Abstract

Objective

To verify the feasibility of non-invasive ventilation (NIV) in immunocompromised children affected by ARDS.

Setting

University Hospital PICU.

Patients

Twenty-three consecutive immunocompromised children treated with NIV for ARDS.

Interventions

All consecutive patients received NIV through a face-mask or a helmet.

Results

No differences were found regarding admission data and severity scores between NIV responders and non-responders. Early and sustained improvement in PaO2/FiO2 ratio were observed in 82 and 74% of cases, respectively. 13 out of 23 patients (54.5%) avoided intubation and were discharged from the PICU; ten patients required intubation: two of them survived and eight patients died (two refractory hypoxemia, three septic shock, three multi-organ failure). PICU and intra-hospital mortality was significantly higher for NIV-nonresponders (P < 0.001). PICU stay was significantly shorter for NIV responders (P = 0.03). NIV responders had significantly lower heart and respiratory rate at the end of treatment (P < 0.001 and P = 0.048, respectively).

Conclusions

NIV administration is feasible and well tolerated in immunocompromised children with ARDS. A short NIV trial can be used to verify the usefulness of the technique. A randomized controlled trial is needed to confirm the efficacy of NIV in immunocompromised children requiring ventilatory support for ARDS.

Partial results from this study were presented at the 9th European Pediatric and Neonatal Ventilation Conference (EPNV 2008), held in Montreux (Switzerland), April 2008.