Noninvasive Ventilation for Pediatric Acute Respiratory Distress Syndrome: Experience From the 2016/2017 Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Prospective Cohort Study.
Por:
Emeriaud G, Pons-Odena M, Bhalla AK, Shein SL, Killien EY, Modesto I Alapont V, Rowan C, Baudin F, Lin JC, Grégoire G, Napolitano N, Mayordomo-Colunga J, Diaz F, Cruces P, Medina A, Smith L and Khemani RG
Publicada:
1 sep 2023
Ahead of Print:
31 may 2023
Resumen:
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, Pao2/Fio2 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, Pao2/Fio2 less than 100, and immunosuppression all present. Among patients with Pao2/Fio2 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.
Filiaciones:
Emeriaud G:
Department of Pediatrics, Pediatric Intensive Care Unit, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
Pons-Odena M:
Inmune and Respiratory Dysfunction in the Child Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa, Esplugues de Llobregat, Spain
Pediatric Intensive Care and Intermediate Care Department, Sant Joan de Déu University Hospital, Universitat de Barcelona, Esplugues de Llobregat, Spain
Bhalla AK:
Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA
Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
Shein SL:
Division of Pediatric Critical Care Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH
Killien EY:
Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
Modesto I Alapont V:
Pediatric Intensive Care Unit, Hospital Universitari I Politècnic La Fe, València, València, Spain
Rowan C:
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN
Baudin F:
Réanimation Pédiatrique, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Lyon, France
Lin JC:
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
Grégoire G:
Applied Clinical Research Unit, CHU Sainte-Justine, Montreal, QC, Canada
Napolitano N:
Respiratory Therapy Department, Children's Hospital of Philadelphia, Philadelphia, PA
Mayordomo-Colunga J:
Department of Pediatrics, Pediatric Intensive Care Unit, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
Inmune and Respiratory Dysfunction in the Child Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa, Esplugues de Llobregat, Spain
Pediatric Intensive Care and Intermediate Care Department, Sant Joan de Déu University Hospital, Universitat de Barcelona, Esplugues de Llobregat, Spain
Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA
Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
Division of Pediatric Critical Care Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH
Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
Pediatric Intensive Care Unit, Hospital Universitari I Politècnic La Fe, València, València, Spain
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN
Réanimation Pédiatrique, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Lyon, France
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
Applied Clinical Research Unit, CHU Sainte-Justine, Montreal, QC, Canada
Respiratory Therapy Department, Children's Hospital of Philadelphia, Philadelphia, PA
Pediatric Intensive Care Unit, Hospital Universitario Central de Asturias, Asturias, Spain
Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Asturias, Spain
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
Escuela de Medicina, Universidad Finis Terrae, Santiago, Chile
Unidad de Paciente Crítico Pediátrico, Hospital El Carmen de Maipú, Santiago de Chile, Chile
Escuela de Medicina Veterinaria, Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, WA
Diaz F:
Escuela de Medicina, Universidad Finis Terrae, Santiago, Chile
Unidad de Paciente Crítico Pediátrico, Hospital El Carmen de Maipú, Santiago de Chile, Chile
Cruces P:
Unidad de Paciente Crítico Pediátrico, Hospital El Carmen de Maipú, Santiago de Chile, Chile
Escuela de Medicina Veterinaria, Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
Medina A:
Pediatric Intensive Care Unit, Hospital Universitario Central de Asturias, Asturias, Spain
Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Asturias, Spain
Smith L:
Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, WA
Khemani RG:
Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA
Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
Green Accepted
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