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Abstract
BACKGROUND: Noninvasive respiratory support (NRS) is widely used in pediatric ICUs (PICUs). However, there is limited experience regarding the utilization of NRS in non-PICU settings. We aimed to evaluate the success rate of NRS in pediatric high-dependency units (PHDUs), identify predictors of NRS failure, quantify adverse events, and assess outcomes.
METHODS: We included infants and children (> 7 d to < 13 y old) admitted to PHDU in 2 tertiary hospitals for acute respiratory distress over a 19-month period. Collected data included diagnosis, type and duration of NRS, adverse events, and the need for PICU transfer or invasive ventilation.
RESULTS: Two hundred and ninety-nine children were included, with a median age of 7 (interquartile range [IQR] 3–25) months and a median weight of 6.1 (IQR 4.3–10.5) kg. Bronchiolitis (37.5%), pneumonia (34.1%), and asthma (12.7%) were the most frequent diagnoses. Median NRS duration was 2 (IQR 1–3) d. At baseline, median SpO2 was 96% (IQR 90–99); median pH was 7.36 (IQR 7.31–7.41), and median PCO2 was 44 (IQR 36–53) mm Hg. Overall, 234 (78.3%) children were successfully managed in PHDU, whereas 65 (21.7%) required transfer to PICU. Thirty-eight (12.7%) needed invasive ventilation on a median time of 43.5 (IQR 13.5–108.0) h. On multivariable analysis, maximum FIO2 > 0.5 (odds ratio 4.49 [95% CI 1.36–14.9], P = .01) and PEEP > 7 cm H2O (odds ratio 3.37 [95% CI 1.49–7.61], P = .004) were predictors for NRS failure. Significant apnea, cardiopulmonary resuscitation, and air leak syndrome were reported in 0.3, 0.7, and 0.7% children, respectively.
CONCLUSIONS: In our cohort, we found NRS in PHDU safe and effective; however, maximum FIO2 > 0.5 post treatment and PEEP > 7 cm H2O were associated with NRS failure.
- noninvasive respiratory support
- children
- respiratory distress syndrome
- airway management
- ICUs
- pediatric
- patient outcome assessment
- Oman
Footnotes
- Correspondence: Khaloud Said Al-Mukhaini MD, Pediatric Intensive Care Section, Department of Child Health, Royal Hospital, P.O. Box 1331, Postal Code 111, Muscat, Oman. E-mail: kholoud_saeed{at}hotmail.com
The authors have disclosed no conflicts of interest.
A version of this paper was presented at the 11th Congress of the World Federation of Pediatric Intensive and Critical Care Societies, held virtually July 12–16, 2022.
Supplementary material related to this paper is available at http://www.rcjournal.com.
- Copyright © 2023 by Daedalus Enterprises
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