A prospective, randomized, controlled trial of noninvasive ventilation in pediatric acute respiratory failure.
RESULTS
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.


METHODS
Prospective, randomized, controlled study. SITE: Two pediatric intensive care units in Santiago, Chile, at Clínica Santa María and Clínica Dávila, respectively.


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.


METHODS
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.
Yañez
Leticia J
LJ
University of Los Andes, Intensive Care Unit, Santa Maria Clinic, Los Andes, Chile [corrected].
Yunge
Mauricio
M
Emilfork
Marcos
M
Lapadula
Michelangelo
M
Alcántara
Alex
A
Fernández
Carlos
C
Lozano
Jaime
J
Contreras
Mariana
M
Conto
Luis
L
Arevalo
Carlos
C
Gayan
Alejandro
A
Hernández
Flora
F
Pedraza
Mariela
M
Feddersen
Marion
M
Bejares
Marcela
M
Morales
Marta
M
Mallea
Fernando
F
Glasinovic
Maritza
M
Cavada
Gabriel
G
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002677:Chile; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000503:physiopathology* / Q000628:therapy*; D014691:Ventilation / Q000379:methods*