[Evaluation of a continuous positive airway pressure system without a ventilator to treat acute respiratory failure in children].
OBJECTIVE
Noninvasive continuous positive airway pressure (CPAP) is widely used in pediatric patients with acute respiratory failure. However, the lack of specific interfaces and appropriate ventilators and poor tolerance of the technique by these patients can lead to failure of the application. The aim of this study was to analyze the efficacy of a CPAP system using a modified Mapleson breathing circuit during acute respiratory failure in pediatric patients.


METHODS
We performed a prospective observational study in children with acute respiratory failure in whom noninvasive ventilation was indicated. CPAP was applied through a Mapleson D circuit fitted with a manometer and a nasopharyngeal tube as the interface. Heart rate, respiratory rate, inspired oxygen fraction (FiO2), PaO2, PaCO2, and pulse oximetry were measured before treatment and after 2 hours of treatment.


RESULTS
Sixteen patients with a mean age of 3.8 years were studied for a period of 18 months. We observed a mean (SD) change in PaCO2 from 66.8 (18.08) mm Hg to 46.48 (5.9) mm Hg after CPAP (P=.16) and a mean change in the PaO2/FiO2 ratio from 201 (111) to 262 (115) after CPAP (P=.30). The mean heart rate fell from 156 (22) beats/min to 127 (18) beats/min (P=.05) and the mean respiratory rate from 53 (15) breaths/min to 33 (13) breaths/min (P<.05). No severe complications were recorded and tolerance was satisfactory. The technique was considered a success in 12 patients (75%).


CONCLUSIONS
CPAP without a ventilator, through a Mapleson D circuit, can be used with a high success rate to provide noninvasive ventilation for pediatric patients with acute respiratory failure.
Sanabria Carretero
P
P
Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid.
Palomero Rodríguez
M A
MA
Laporta Báez
Y
Y
Suso Martínez de Bujo
B
B
Suárez Gonzalo
L
L
Muriel Villoria
C
C
D000208:Acute Disease; D002245:Carbon Dioxide / Q000097:blood; D002648:Child; D002675:Child, Preschool; D045422:Continuous Positive Airway Pressure / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D005260:Female; D006339:Heart Rate; D006801:Humans; D006935:Hypercapnia / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D000860:Hypoxia / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007440:Intubation; D008297:Male; D009296:Nasal Cavity; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D010342:Patient Acceptance of Health Care; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000097:blood / Q000150:complications / Q000628:therapy*
D002245:Carbon Dioxide; D010100:Oxygen