A prospective, randomized, controlled trial of noninvasive ventilation in pediatric acute respiratory failure.

Author(s): Yanez LJ, Yunge M, Emilfork M, Lapadula M, Alcantara A, Fernandez C, Hernandez F, Catalan C, Conto L, Arevalo C, Landeros J

Affiliation(s): From the Department of Pediatrics (LJY, ME, ML, AA, CF), PICU Santa Maria Clinic, University of Los Andes, Chile; and Department of Pediatrics (MY, FH, CC, LC, CA, JL), PICU Davila Clinic, University of Los Andes, Chile.

Publication date & source: 2008-08-01, Pediatr Crit Care Med., [Epub ahead of print]

Publication type:

OUTCOMES:: To (a) compare the benefits of noninvasive ventilation (NIV) plus standard therapy vs. standard therapy alone in children with acute respiratory failure; (b) assess method effectiveness in improving gas exchange and vital signs; and (c) assess method safety. DESIGN:: Prospective, randomized, controlled study. SITE:: Two pediatric intensive care units in Santiago, Chile, at Clinica Santa Maria and Clinica Davila, respectively. PATIENTS AND METHODS:: Fifty patients with acute respiratory failure admitted to pediatric intensive care units were recruited; 25 patients were randomly allocated to noninvasive inspiratory positive airway pressure and expiratory positive airway pressure plus standard therapy (study group); the remaining 25 were given standard therapy (control group). Both groups were comparable in demographic terms. INTERVENTIONS AND MEASUREMENTS:: The study group received NIV under inspiratory positive airway pressure ranging between 12 cm and 18 cm H2O and expiratory positive airway pressure between 6 cm and 12 cm H2O. Vital signs (cardiac and respiratory frequency), Po2, Pco2, pH, and Po2/Fio2 were recorded at the start and 1, 6, 12, 24, and 48 hrs into the study. RESULTS:: Heart rate and respiratory rate improved significantly with NIV. Heart rate and respiratory rate were significantly lower after 1 hr of treatment compared with admission (p = 0.0009 and p = 0.004, respectively). The trend continued over time, heart rate being significantly lower than control after the first hour and heart rate after 6 hrs. With NIV, Po2/Fio2 improved significantly from the first hour. The endotracheal intubation was significantly lower (28%) in the NIV group than in the control group (60%; p = 0.045). CONCLUSIONS:: NIV improves hypoxemia and the signs and symptoms of acute respiratory failure. NIV seems to afford these patients protection from endotracheal intubation.