Intensive Care Medicine

, Volume 39, Issue 6, pp 1095–1103 | Cite as

Predicting non-invasive ventilation failure in children from the SpO2/FiO2 (SF) ratio

  • Juan Mayordomo-ColungaEmail author
  • Martí Pons
  • Yolanda López
  • M. José Solana
  • Corsino Rey
  • Pablo Martínez-Camblor
  • Antonio Rodríguez-Núñez
  • Jesús López-Herce
  • Alberto Medina
  • Clara Abadesso
  • M. Ángeles García-Teresa
  • Mirella Gáboli
  • Milagros García-López
  • María González-Sánchez
  • Paula Madurga-Revilla
  • Amelia González-Calvar
  • Eider Oñate
Pediatric Original



Our objective was to assess whether SpO2/FiO2 (SF) ratio could be a useful NIV outcome predictor in children with acute respiratory failure (ARF) and tried to develop a predictive model of NIV failure.


Prospective, observational, multicenter study. Episodes of ARF-fulfilling inclusion criteria from 15 January 2010 to 14 January 2011 were treated with NIV according to a pre-established protocol. Clinical variables were collected at baseline and at 1, 2, 6, 12 and 24 h. Failure criterion was the need for endotracheal intubation. Failures were considered as “early” if occurring ≤6 h after NIV initiation, “intermediate” if occurring between 6 and 24 h, and “late” if occurring after 24 h. Variables with a p < 0.1 in univariate analysis corrected by age were included in multivariate analysis. Models were calculated based on multivariate analysis.


During the study period, 390 episodes were included. NIV success rate was 81.3 %. Among ARF causes, failure occurred most frequently in ARDS episodes. The failure predictive model for the whole sample included SF ratio at 1 h, age and PRISM III-24 (area under the curve AUC of 0.755). For early NIV failures, SF ratio at 1 h was the only variable within model (AUC 0.748). The analysis of intermediate NIV failures identified 3 variables independently linked to NIV outcome: PRISM III-24, RR decrease at 6 h, and SF ratio at 6 h (AUC 0.895). No model was identified for late NIV failure.


SF ratio is a reliable predictor of early NIV failure in children.


Non invasive positive-pressure ventilation Acute respiratory failure Clinical markers Hypoxemia Mechanical ventilation Pediatrics 



Authors would like to thank all residents and PICU nurse and medical staff for their invaluable support. Also thanks to Paul Harris and Wee Tan for their style corrections.


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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2013

Authors and Affiliations

  • Juan Mayordomo-Colunga
    • 1
    • 2
    Email author
  • Martí Pons
    • 3
  • Yolanda López
    • 4
  • M. José Solana
    • 5
  • Corsino Rey
    • 2
  • Pablo Martínez-Camblor
    • 6
  • Antonio Rodríguez-Núñez
    • 7
  • Jesús López-Herce
    • 5
  • Alberto Medina
    • 2
  • Clara Abadesso
    • 8
  • M. Ángeles García-Teresa
    • 9
  • Mirella Gáboli
    • 10
    • 11
  • Milagros García-López
    • 12
  • María González-Sánchez
    • 2
  • Paula Madurga-Revilla
    • 13
  • Amelia González-Calvar
    • 14
  • Eider Oñate
    • 15
  1. 1.Department of PaediatricsHospital San Agustín AvilésAsturiasSpain
  2. 2.Pediatric Intensive Care Unit, Department of PediatricsHospital Universitario Central de Asturias, University of OviedoOviedoSpain
  3. 3.Pediatric Intensive Care UnitHospital Sant Joan de DéuBarcelonaSpain
  4. 4.Pediatric Intensive Care UnitHospital de CrucesBaracaldoSpain
  5. 5.Pediatric Intensive Care DepartmentHospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio MarañónMadridSpain
  6. 6.Oficina de Investigación Biosanitaria de AsturiasOviedoSpain
  7. 7.Pediatric Emergency and Critical Care Division, Department of PediatricsHospital Clinico Universitario de Santiago de Compostela, SergasSantiago de CompostelaSpain
  8. 8.Department of PediatricsHospital Fernando FonsecaLisbonPortugal
  9. 9.Pediatric Intensive Care DepartmentHospital Infantil Universitario Niño JesúsMadridSpain
  10. 10.Pediatric Intensive Care Unit. Department of Pediatrics, Hospital Universitario de SalamancaUniversidad de SalamancaSalamancaSpain
  11. 11.Departamento de Obstetricia Ginecología y Pediatría, Facultad de MedicinaUniversidad de SalamancaSalamancaSpain
  12. 12.Pediatric Intensive Care UnitHospital Sao JoaoPortoPortugal
  13. 13.Pediatric Intensive Care UnitHospital Infantil Miguel ServetZaragozaSpain
  14. 14.Pediatric Intensive Care UnitHospital Universitario Son EspasesPalma de MallorcaSpain
  15. 15.Pediatric Intensive Care UnitHospital DonostiaSan SebastiánSpain

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