Noninvasive ventilation as the first choice of ventilatory support in children

ABSTRACT Objective: To describe the use of noninvasive ventilation to prevent tracheal intubation in children in a pediatric intensive care unit and to analyze the factors related to respiratory failure. Methods: A retrospective cohort study was performed from January 2016 to May 2018. The study population included children aged 1 to 14 years who were subjected to noninvasive ventilation as the first therapeutic choice for acute respiratory failure. Biological, clinical and managerial data were analyzed by applying a model with the variables that obtained significance ≤ 0.20 in a bivariate analysis. Logistic regression was performed using the ENTER method. The level of significance was set at 5%. Results: The children had a mean age of 68.7 ± 42.3 months, 96.6% had respiratory disease as a primary diagnosis, and 15.8% had comorbidities. Of the 209 patients, noninvasive ventilation was the first option for ventilatory support in 86.6% of the patients, and the fraction of inspired oxygen was ≥ 0.40 in 47% of the cases. The lethality rate was 1.4%. The data for the use of noninvasive ventilation showed a high success rate of 95.3% (84.32 - 106). The Pediatric Risk of Mortality (PRISM) score and the length of stay in the intensive care unit were the significant clinical variables for the success or failure of noninvasive ventilation. Conclusion: A high rate of effectiveness was found for the use of noninvasive ventilation for acute episodes of respiratory failure. A higher PRISM score on admission, comorbidities associated with respiratory symptoms and oxygen use ≥ 40% were independent factors related to noninvasive ventilation failure.

摘要
目的：描述儿科重症监护病房（pediatric intensive care unit）中应用无创通气（noninvasive ventilation）预防儿童气管插管的情况，并分析与呼吸衰竭相关的影响因素。
方法：本研究为2016年1月至2018年5月开展的回顾性队列研究。研究对象为1~14岁、以无创通气作为急性呼吸衰竭首选治疗方案的儿童。通过双变量分析筛选出显著性P值≤0.20的变量，构建回归模型对患儿的生物学、临床及诊疗管理数据进行分析；采用ENTER法进行logistic回归分析，设定显著性检验水准为5%。
结果：本研究共纳入209例患儿，平均年龄为68.7±42.3月龄；96.6%的患儿以呼吸系统疾病为首要诊断，15.8%存在合并症。86.6%的患儿首选无创通气作为呼吸支持方案，47%的病例吸入氧分数（fraction of inspired oxygen）≥0.40；总体病死率为1.4%。无创通气的整体成功率达95.3%（84.32~106）。小儿死亡风险评分（Pediatric Risk of Mortality，PRISM）及重症监护病房住院时长是影响无创通气成功与否的显著临床变量。
结论：针对急性呼吸衰竭发作应用无创通气的有效性较高。入院时较高的PRISM评分、伴随呼吸道症状的合并症及吸入氧浓度≥40%是与无创通气失败相关的独立危险因素。