title: The number of failing organs predicts non-invasive ventilation failure in children with ALI/ARDS.
abstract: OBJECTIVE
  Non-invasive positive pressure ventilation (NIV) is being increasingly used in paediatric critical care, although its use in acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) is still debated. No definite data are available for the prediction of NIV outcome in such selected populations. We aimed to identify which factors might affect NIV failure in paediatric ALI/ARDS patients.
  
  
  METHODS
  A retrospective cohort study using comprehensive predictivity analysis was performed. All children admitted to our paediatric intensive care unit over a 4-year period for ALI/ARDS were reviewed. Basic, clinical, physiological parameters and their change after 1 h of NIV were considered and subjected to univariate analysis. Candidate prognostic variables were then subjected to multicollinearity scrutiny and logistic regression. Finally, variables significant in the logistic regression were subjected to predictivity analysis.
  
  
  RESULTS
  The number of organ failures at admission (NOF) is a strong predictor of NIV failure (odds ratio 5.26; p = 0.004). Having only one organ failure provides a probability of NIV success of 85.7% (sensitivity 87%; specificity 49%). One NIV failure will be predicted and avoided for every four cases in which the presence of other organ failures is incorporated into the clinical decision.
  
  
  CONCLUSIONS
  NOF significantly predicts the NIV failure. Children with no organ failures other than ALI/ARDS may safely be treated with NIV.
authors.affiliation: Paediatric Intensive Care Unit, Department of Anaesthesiology and Intensive Care University Hospital A. Gemelli, Catholic University of the Sacred Heart, L.go A. Gemelli 8, 00168 Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Piastra
authors.forename: Daniele
authors.initials: D
authors.lastname: De Luca
authors.forename: Laura
authors.initials: L
authors.lastname: Marzano
authors.forename: Eleonora
authors.initials: E
authors.lastname: Stival
authors.forename: Orazio
authors.initials: O
authors.lastname: Genovese
authors.forename: Domenico
authors.initials: D
authors.lastname: Pietrini
authors.forename: Giorgio
authors.initials: G
authors.lastname: Conti
mesh_terms: D055371:Acute Lung Injury / Q000503:physiopathology*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005544:Forecasting; D006801:Humans; D015278:Intensive Care Units, Pediatric; D009102:Multiple Organ Failure / Q000209:etiology*; D016017:Odds Ratio; D011175:Positive-Pressure Respiration / Q000009:adverse effects*; D011379:Prognosis; D012128:Respiratory Distress Syndrome / Q000503:physiopathology*; D012189:Retrospective Studies