Noninvasive Ventilation for Pediatric Acute Respiratory Distress Syndrome: Experience from the 2016/2017 Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Prospective Cohort Study

Guillaume Emeriaud, Marti Pons-Odena, Anoopindar K. Bhalla, Steven L. Shein, Elizabeth Y. Killien, Vicent Modesto I Alapont, Courtney Rowan, Florent Baudin, John C. Lin, Gabrielle Gregoire, Natalie Napolitano, Juan Mayordomo-Colunga, Franco Diaz, Pablo Cruces, Alberto Medina, Lincoln Smith, Robinder G. Khemani

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)

Abstract

OBJECTIVES: The worldwide practice and impact of noninvasive ventilation (NIV) in pediatric acute respiratory distress syndrome (PARDS) is unknown. We sought to describe NIV use and associated clinical outcomes in PARDS. DESIGN: Planned ancillary study to the 2016/2017 prospective Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology study. SETTING: One hundred five international PICUs. PATIENTS: Patients with newly diagnosed PARDS admitted during 10 study weeks. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Children were categorized by their respiratory support at PARDS diagnosis into NIV or invasive mechanical ventilation (IMV) groups. Of 708 subjects with PARDS, 160 patients (23%) received NIV at PARDS diagnosis (NIV group). NIV failure rate (defined as tracheal intubation or death) was 84 of 160 patients (53%). Higher nonrespiratory pediatric logistic organ dysfunction (PELOD-2) score, Pao2/Fio2was less than 100 at PARDS diagnosis, immunosuppression, and male sex were independently associated with NIV failure. NIV failure was 100% among patients with nonrespiratory PELOD-2 score greater than 2, Pao2/Fio2less than 100, and immunosuppression all present. Among patients with Pao2/Fio2greater than 100, children in the NIV group had shorter total duration of NIV and IMV, than the IMV at initial diagnosis group. We failed to identify associations between NIV use and PICU survival in a multivariable Cox regression analysis (hazard ratio 1.04 [95% CI, 0.61-1.80]) or mortality in a propensity score matched analysis (p = 0.369). CONCLUSIONS: Use of NIV at PARDS diagnosis was associated with shorter exposure to IMV in children with mild to moderate hypoxemia. Even though risk of NIV failure was high in some children, we failed to identify greater hazard of mortality in these patients.

Original languageEnglish
Pages (from-to)715-726
Number of pages12
JournalPediatric Critical Care Medicine
Volume24
Issue number9
DOIs
Publication statusPublished - 1 Sept 2023

Keywords

  • immunosuppression
  • mechanical ventilation
  • pediatric critical care
  • respiratory distress
  • tracheal intubation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

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