title: Predicting non-invasive ventilation failure in children from the SpO₂/FiO₂ (SF) ratio.
abstract: OBJECTIVE
  Our objective was to assess whether SpO₂/FiO₂ (SF) ratio could be a useful NIV outcome predictor in children with acute respiratory failure (ARF) and tried to develop a predictive model of NIV failure.
  
  
  METHODS
  Prospective, observational, multicenter study. Episodes of ARF-fulfilling inclusion criteria from 15 January 2010 to 14 January 2011 were treated with NIV according to a pre-established protocol. Clinical variables were collected at baseline and at 1, 2, 6, 12 and 24 h. Failure criterion was the need for endotracheal intubation. Failures were considered as "early" if occurring ≤6 h after NIV initiation, "intermediate" if occurring between 6 and 24 h, and "late" if occurring after 24 h. Variables with a p < 0.1 in univariate analysis corrected by age were included in multivariate analysis. Models were calculated based on multivariate analysis.
  
  
  RESULTS
  During the study period, 390 episodes were included. NIV success rate was 81.3 %. Among ARF causes, failure occurred most frequently in ARDS episodes. The failure predictive model for the whole sample included SF ratio at 1 h, age and PRISM III-24 (area under the curve AUC of 0.755). For early NIV failures, SF ratio at 1 h was the only variable within model (AUC 0.748). The analysis of intermediate NIV failures identified 3 variables independently linked to NIV outcome: PRISM III-24, RR decrease at 6 h, and SF ratio at 6 h (AUC 0.895). No model was identified for late NIV failure.
  
  
  CONCLUSIONS
  SF ratio is a reliable predictor of early NIV failure in children.
authors.affiliation: Department of Paediatrics, Hospital San Agustín Avilés, Asturias, Spain. jmcolunga@hotmail.com
authors.forename: Juan
authors.initials: J
authors.lastname: Mayordomo-Colunga
authors.forename: Martí
authors.initials: M
authors.lastname: Pons
authors.forename: Yolanda
authors.initials: Y
authors.lastname: López
authors.forename: M
authors.initials: M
authors.lastname: José Solana
authors.forename: Corsino
authors.initials: C
authors.lastname: Rey
authors.forename: Pablo
authors.initials: P
authors.lastname: Martínez-Camblor
authors.forename: Antonio
authors.initials: A
authors.lastname: Rodríguez-Núñez
authors.forename: Jesús
authors.initials: J
authors.lastname: López-Herce
authors.forename: Alberto
authors.initials: A
authors.lastname: Medina
authors.forename: Clara
authors.initials: C
authors.lastname: Abadesso
authors.forename: M
authors.initials: M
authors.lastname: Angeles García-Teresa
authors.forename: Mirella
authors.initials: M
authors.lastname: Gáboli
authors.forename: Milagros
authors.initials: M
authors.lastname: García-López
authors.forename: María
authors.initials: M
authors.lastname: González-Sánchez
authors.forename: Paula
authors.initials: P
authors.lastname: Madurga-Revilla
authors.forename: Amelia
authors.initials: A
authors.lastname: González-Calvar
authors.forename: Eider
authors.initials: E
authors.lastname: Oñate
mesh_terms: D001784:Blood Gas Analysis; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008991:Monitoring, Physiologic; D063087:Noninvasive Ventilation; D010100:Oxygen / Q000097:blood*; D010101:Oxygen Consumption / Q000502:physiology*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000628:therapy*; D017211:Treatment Failure
chemical_list: D010100:Oxygen