Implications of sedation during the use of noninvasive ventilation in children with acute respiratory failure (SEDANIV Study).
Por:
Bermúdez-Barrezueta L, Mayordomo-Colunga J, Miñambres-Rodríguez M, Reyes S, Valencia-Ramos J, Lopez-Fernandez YM, Mendizábal-Diez M, Vivanco-Allende A, Palacios-Cuesta A, Oviedo-Melgares L, Unzueta-Roch JL, López-González J, Jiménez-Villalta MT, Cuervas-Mons Tejedor M, Artacho González L, Jiménez Olmos A and Pons-Odena M
Publicada:
11 jul 2024
Ahead of Print:
11 jul 2024
Resumen:
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 SpO(2)/FiO(2) 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 SpO(2)/FiO(2) 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, SpO(2) at 3 h, FiO(2) 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.
Filiaciones:
Bermúdez-Barrezueta L:
Pediatric and Neonatal Intensive Care, Department of Pediatrics, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal, 3, 47003, Valladolid, Spain
Department of Pediatrics, Faculty of Medicine, Valladolid University, Valladolid, Spain
Mayordomo-Colunga J:
Pediatric Intensive Care Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
Department of Pediatrics, University of Oviedo, Oviedo, Spain
Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS), Instituto de Salud Carlos III, RD21/0012/0020, Madrid, Spain
Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
Miñambres-Rodríguez M:
Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
Reyes S:
Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
Valencia-Ramos J:
Pediatric Intensive Care Unit, Department of Pediatrics, Complejo Asistencial Universitario de Burgos, Burgos, Spain
Ciencias de la Salud, University of Burgos, Burgos, Spain
Lopez-Fernandez YM:
Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario de Cruces, BioBizkaia-Bizkaia Health Research Institute, Bizkaia, Spain
Mendizábal-Diez M:
Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario de Navarra, Pamplona, Spain
Vivanco-Allende A:
Pediatric Intensive Care Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
Palacios-Cuesta A:
Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario, 12 de Octubre, Madrid, Spain
Oviedo-Melgares L:
Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario, 12 de Octubre, Madrid, Spain
Unzueta-Roch JL:
Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
López-González J:
Pediatric Intensive Care Unit Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
Jiménez-Villalta MT:
Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario Reina Sofía, Córdoba, Spain
Cuervas-Mons Tejedor M:
Pediatric Intensive Care Unit, Department of Pediatrics, Complejo Asistencial Universitario de Burgos, Burgos, Spain
Artacho González L:
Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Regional Universitario de Málaga, Málaga, Spain
Jiménez Olmos A:
Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario Miguel Servet, Zaragoza, Spain
Pons-Odena M:
Inmune and Respiratory Dysfunction Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950, Esplugues de Llobregat, Spain
Pediatric Intensive Care and Intermediate Care Department, Hospital Universitario Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat, Spain
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