title: Noninvasive positive pressure ventilation in critically ill children with cardiac disease.
abstract: Noninvasive ventilation is effective in respiratory failure from various etiologies. This study aimed to analyze the efficacy of noninvasive positive pressure ventilation (NPPV) in pediatric cardiac patients. NPPV was used (1) as an alternative means of respiratory support in patients with hypoxemic or hypercarbic respiratory failure or with signs of respiratory distress that were considered to require intubation; or (2) as a preventive measure in patients with high risk for extubation failure. Between 2008 and 2011, there were 107 episodes of NPPV use in 82 patients. Their median age was 57 days (range 1 day to 18 years), and weight was 4.1 kg (range 1.7-68). Within the first hour of NPPV, partial pressure of carbon dioxide/fraction of inspired oxygen (PaO2/FiO2) was significantly increased, and arterial pCO2, and respiratory rate were decreased. This decrease in respiratory rate and increase in PaO 2/FiO2 continued during the first 24 h of therapy, and pCO2 was decreased during the first 6 h. In 59.8% of cases, NPPV was successfully used without the need for tracheal intubation. The Aristotle Basic Complexity score, presence of infection, residual cardiac defect, and pH <7.36 in the first hour were independent predictors of NPPV failure. We conclude that NPPV improved oxygenation and decreased respiratory effort in pediatric cardiac patients, 59.8% of whom eventually did not receive intubation. A high-complexity surgical score, presence of infection, residual cardiac defect, and pH <7.36 in the first hour are predictors of NPPV failure, which occurs in most patients >24 h after the onset of therapy.
authors.affiliation: Pediatric Cardiac Intensive Care Unit, National Institute of Cardiovascular Diseases, Limbova 1, 833 51, Bratislava, Slovakia, lkovacikova@yahoo.com.
authors.forename: Lubica
authors.initials: L
authors.lastname: Kovacikova
authors.forename: Peter
authors.initials: P
authors.lastname: Skrak
authors.forename: Dusan
authors.initials: D
authors.lastname: Dobos
authors.forename: Martin
authors.initials: M
authors.lastname: Zahorec
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000150:complications*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D063087:Noninvasive Ventilation / Q000379:methods*; D011175:Positive-Pressure Respiration / Q000379:methods*; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome