Time for noninvasive ventilation in children with acute respiratory failure

IntroductionGiven that invasive ventilation (IV) is associated with many complications, recently there is an increased interest to noninvasive ventilation (NIV).ObjectiveTo assess the efficacy of NIV in children with acute respiratory failure (ARF) and to compare PICU stay, hospital stay and the mortality rate in children with ARF treated with IV and NIV.MethodsThis is a prospective study and includes all patients diagnosed with ARF (hypoxemic or hypercapnic) of different causes, requiring ventilator support during two years. Clinical and physiological criteria for inclusion and exclusion have been determined according ESPNIC recommendations. The study is divided into two periods: first period – all children with ARF who meet the criteria for ventilator support are placed on IV; second period – as the first line of treatment was applied NIV.ResultsThe study included a total of 79 children with ARF. IV was avoided in 73.8% of cases by using NIV. Compared with the IV group, both hospital stay and PICU stay in the NIV group were lower (9.5 vs 12.6 and 7.4 vs 11.2 days), leading to a significant reduction in the ARF treatment costs (1.9 times higher in IV than NIV). Complications in NIV group were reduced by 9.5% vs 40.5% in IV group, and mortality rate also resulted significantly lower in the NIV group (16% vs 40%); OR = 3.4, 95% CI (1.20–9.68).ConclusionIV can be avoided in 70% of children with ARF by using NIV, with a significant reduction of complications, PICU stay and mortality rate.