Original Article

World Journal of Pediatrics

, Volume 6, Issue 4, pp 323-330

Noninvasive ventilation in pediatric acute respiratory failure by means of a conventional volumetric ventilator

  • Juan I. Muñoz-BonetAffiliated withPediatric Intensive Care Unit, Hospital Clínico UniversitarioUCIP Hospital Clínico Universitario, Avda Email author 
  • , Eva M. Flor-MaciánAffiliated withPediatric Intensive Care Unit, Hospital Clínico Universitario
  • , Patricia M. RosellóAffiliated withPediatric Intensive Care Unit, Hospital Clínico Universitario
  • , Mari C. LlopisAffiliated withPediatric Service, Hospital Clínico Universitario
  • , Alicia LizondoAffiliated withPediatric Service, Hospital Clínico Universitario
  • , José L. López-PratsAffiliated withPediatric Intensive Care Unit, Hospital Clínico Universitario
  • , Juan BrinesAffiliated withPediatric Service, Hospital Clínico Universitario

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Abstract

Background

Acute respiratory failure (ARF) is one of the main causes for admission to pediatric intensive care unit (PICU). This study aimed to evaluate the feasibility and outcome of noninvasive ventilation (NIV) by a volumetric ventilator with a specific mode in pediatric acute respiratory failure.

Methods

A three-year prospective non-controlled study was undertaken in children with ARF who had received NIV delivered by Evita 2 Dura with NIV mode through a nonvented oronasal mask.

Results

Thirty-two episodes of ARF were observed in 26 patients. Pneumonia was observed in most of the children (46.8%). Pediatric logistic organ dysfunction (PELOD) score was 12.4%±24% (range 0–84%). Peak inspiratory pressure was 18.5±2.7 cmH2O, positive endexpiratory pressure 5.7±1.1 cmH2O, pressure support 10.5±2.7 cmH2O, and mean pressure 9.2±2 cmH2O. The clinical score was improved progressively within the first 6 hours. Before the initiation of NIV, respiratory rate was 41.7±16.3, heart rate 131.6±25.8, systolic arterial pressure 108±19.5, diastolic arterial pressure 58.2±13.9, pH 7.33±0.12, pCO2 55.1±20.2, SatO2 87.8±9.9 and FiO2 0.55±0.25. There was a significant improvement in the respiratory rate, heart rate, pH, pCO2 and SatO2 at 2–4 hours. This improvement was kept throughout the first 24 hours. The level of FiO2 was significantly lower at 24 hours. Radiological improvement was observed after 24 hours in 17 out of 26 patients. The duration of NIV was 85.4±62.8 hours. Complications were defined as minor. Only 4 patients required intubation. All patients survived.

Conclusions

NIV can be successfully applied to infants and children with ARF using this volumetric ventilator with specific NIV mode. It should be considered particularly in children whose underlying condition warrants avoidance of intubation.

Key words

acute respiratory failure children conventional volumetric ventilator noninvasive positive pressure ventilation pneumonia