Noninvasive pressure-support ventilation in immunocompromised children with ARDS: a feasibility study.
OBJECTIVE
To verify the feasibility of non-invasive ventilation (NIV) in immunocompromised children affected by ARDS.


METHODS
University Hospital PICU.


METHODS
Twenty-three consecutive immunocompromised children treated with NIV for ARDS.


METHODS
All consecutive patients received NIV through a face-mask or a helmet.


RESULTS
No differences were found regarding admission data and severity scores between NIV responders and non-responders. Early and sustained improvement in PaO2/FiO2 ratio were observed in 82 and 74% of cases, respectively. 13 out of 23 patients (54.5%) avoided intubation and were discharged from the PICU; ten patients required intubation: two of them survived and eight patients died (two refractory hypoxemia, three septic shock, three multi-organ failure). PICU and intra-hospital mortality was significantly higher for NIV-nonresponders (P < 0.001). PICU stay was significantly shorter for NIV responders (P = 0.03). NIV responders had significantly lower heart and respiratory rate at the end of treatment (P < 0.001 and P = 0.048, respectively).


CONCLUSIONS
NIV administration is feasible and well tolerated in immunocompromised children with ARDS. A short NIV trial can be used to verify the usefulness of the technique. A randomized controlled trial is needed to confirm the efficacy of NIV in immunocompromised children requiring ventilatory support for ARDS.
Piastra
Marco
M
Pediatric Intensive Care Unit, Department of Anaesthesiology and Intensive Care, Catholic University of the Sacred Heart, University Hospital A.Gemelli, L.go A. Gemelli 8, 00168 Rome, Italy.
De Luca
Daniele
D
Pietrini
Domenico
D
Pulitanò
Silvia
S
D'Arrigo
Sonia
S
Mancino
Aldo
A
Conti
Giorgio
G
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D015278:Intensive Care Units, Pediatric; D008297:Male; D011175:Positive-Pressure Respiration; D012128:Respiratory Distress Syndrome; D016896:Treatment Outcome