A prospective, randomized, controlled trial of noninvasive ventilation in pediatric acute respiratory failure *.
Yanez, Leticia J. MD; Yunge, Mauricio MD; Emilfork, Marcos MD; Lapadula, Michelangelo MD; Alcantara, Alex MD; Fernandez, Carlos MD; Lozano, Jaime MD; Contreras, Mariana MD; Conto, Luis MD; Arevalo, Carlos MD; Gayan, Alejandro MD; Hernandez, Flora RN; Pedraza, Mariela MD; Feddersen, Marion MD; Bejares, Marcela MD; Morales, Marta MD; Mallea, Fernando MD; Glasinovic, Maritza MD; Cavada, Gabriel PhD
Pediatric Critical Care Medicine.
9(5):484-489, September 2008.
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Outcomes: To compare the benefits of noninvasive ventilation (NIV) plus standard therapy vs. standard therapy alone in children with acute respiratory failure; assess method effectiveness in improving gas exchange and vital signs; and assess method safety.
Design: Prospective, randomized, controlled study.
Site: Two pediatric intensive care units in Santiago, Chile, at Clinica Santa Maria and Clinica Davila, respectively.
Patients and Methods: Fifty patients with acute respiratory failure admitted to pediatric intensive care units were recruited; 25 patients were randomly allocated to noninvasive inspiratory positive airway pressure and expiratory positive airway pressure plus standard therapy (study group); the remaining 25 were given standard therapy (control group). Both groups were comparable in demographic terms.
Interventions and Measurements: The study group received NIV under inspiratory positive airway pressure ranging between 12 cm and 18 cm H2O and expiratory positive airway pressure between 6 cm and 12 cm H2O. Vital signs (cardiac and respiratory frequency), Po2, Pco2, pH, and Po2/Fio2 were recorded at the start and 1, 6, 12, 24, and 48 hrs into the study.
Results: Heart rate and respiratory rate improved significantly with NIV. Heart rate and respiratory rate were significantly lower after 1 hr of treatment compared with admission (p = 0.0009 and p = 0.004, respectively). The trend continued over time, heart rate being significantly lower than control after the first hour and heart rate after 6 hrs. With NIV, Po2/Fio2 improved significantly from the first hour. The endotracheal intubation was significantly lower (28%) in the NIV group than in the control group (60%; p = 0.045).
Conclusions: NIV improves hypoxemia and the signs and symptoms of acute respiratory failure. NIV seems to afford these patients protection from endotracheal intubation. (Pediatr Crit Care Med 2008; 9:484-489)
(C)2008The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies