Noninvasive ventilation in pediatric acute respiratory failure by means of a conventional volumetric ventilator

Background: To evaluate the feasibility and outcome of noninvasive ventilation (NIV) by volumetric ventilator with specific NIV mode in pediatric acute respiratory failure (ARF). Methods: Prospective non controlled study in children with ARF who received NIV delivered by Evita 2 Dura with NIV mode, through a nonvented oronasal mask, for three years. Results: 32 episodes of ARF in 26 patients. Pneumonia was the most frequent diagnosis (46.8%). Pediatric logistic organ dysfunction (PELOD) score was 12.4%±24% (range 0-84%). The highest set of parameters: peak inspiratory pressure 18.5±2.7 cmH2O (15-26); positive end-expiratory pressure 5.7±1.1 cmH2O (4-9), pressure support 10.5±2.7 cmH2O (5-18) and mean pressure 9.2±2 cmH2O (6-14). There was a progressive clinical score improvement within the first 6 hours. The following results were obtained before initiating NIV: Respiratory rate 41.7±16.3, heart rate 131.6±25.8, systolic arterial pressure 108±19.5, diastolic arterial pressure 58.2±13.9, pH 7.33±0.12, pCO2 55.1±20.2, SatO2 87.8±9.9 and FiO2 0.55±0.25. A significant improvement in respiratory and heart rate, pH, pCO2 and SatO2 was reported at 2-4 hours. This improvement was maintained in throughout the first 24 hours. The FiO2 was significantly lower at 24 hours. Radiological improvement was observed after 24 hours in 17 out of 26 cases. The duration of NIV was 85.4±62.8 hours. Complications were defined as minor. Only 4 patients required intubation. All patients survived. Conclusions: NIV can be successfully applied to infants and children with ARF using this volumetric ventilator with specific NIV mode. It should be considered particularly in children whose underlying condition warrants avoidance of intubation.