title: Non invasive ventilation after extubation in paediatric patients: a preliminary study.
abstract: BACKGROUND
  Non-invasive ventilation (NIV) may be useful after extubation in children. Our objective was to determine postextubation NIV characteristics and to identify risk factors of postextubation NIV failure.
  
  
  METHODS
  A prospective observational study was conducted in an 8-bed pediatric intensive care unit (PICU). Following PICU protocol, NIV was applied to patients who had been mechanically ventilated for over 12 hours considered at high-risk of extubation failure -elective NIV (eNIV), immediately after extubation- or those who developed respiratory failure within 48 hours after extubation -rescue NIV (rNIV)-. Patients were categorized in subgroups according to their main underlying conditions. NIV was deemed successful when reintubation was avoided. Logistic regression analysis was performed in order to identify predictors of NIV failure.
  
  
  RESULTS
  There were 41 episodes (rNIV in 20 episodes). Success rate was 50% in rNIV and 81% in eNIV (p = 0.037). We found significant differences in univariate analysis between success and failure groups in respiratory rate (RR) decrease at 6 hours, FiO2 at 1 hour and PO2/FiO2 ratio at 6 hours. Neurologic condition was found to be associated with NIV failure. Multiple logistic regression analysis identified no variable as independent NIV outcome predictor.
  
  
  CONCLUSIONS
  Our data suggest that postextubation NIV seems to be useful in avoiding reintubation in high-risk children when applied immediately after extubation. NIV was more likely to fail when ARF has already developed (rNIV), when RR at 6 hours did not decrease and if oxygen requirements increased. Neurologic patients seem to be at higher risk of reintubation despite NIV use.
authors.affiliation: Paediatric Intensive Care Unit, Department of Paediatrics, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Spain. jmcolunga@hotmail.com
authors.forename: Juan
authors.initials: J
authors.lastname: Mayordomo-Colunga
authors.forename: Alberto
authors.initials: A
authors.lastname: Medina
authors.forename: Corsino
authors.initials: C
authors.lastname: Rey
authors.forename: Andrés
authors.initials: A
authors.lastname: Concha
authors.forename: Sergio
authors.initials: S
authors.lastname: Menéndez
authors.forename: Marta
authors.initials: M
authors.lastname: Los Arcos
authors.forename: Irene
authors.initials: I
authors.lastname: García
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D016015:Logistic Models; D008297:Male; D011175:Positive-Pressure Respiration / Q000379:methods* / Q000706:statistics & numerical data; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D056152:Respiratory Rate; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000379:methods* / Q000706:statistics & numerical data
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