title: The Cause of Acute Respiratory Failure Predicts the Outcome of Noninvasive Ventilation in Immunocompromised Children.
abstract: BACKGROUND
  Noninvasive ventilation (NIV) may be superior to conventional therapy in immunocompromised children with respiratory failure.
  
  
  METHODS
  Mortality, success rate, prognostic factors and side effects of NIV for acute respiratory failure (ARF) were investigated retrospectively in 41 in children with primary immunodeficiency, after stem cell transplantation or chemotherapy for oncologic disease.
  
  
  RESULTS
  In 11/41 (27%) children invasive ventilation was avoided and patients were discharged from ICU. In children with NIV failure ICU-mortality was 19/30 (63%). 8/11 (72%) children with NIV success had recurrence of ARF after 27 days. Only 4/11 (36%) children with first episode NIV success and 8/30 (27%) with NIV failure survived to hospital discharge. Lower FiO2, SpO2/FiO2 and blood culture positive bacterial sepsis were predictive for NIV success, while fungal sepsis or culture negative ARF were predictive for NIV failure. We observed catecholamine treatment in 14/41 (34%), pneumothorax in 2/41 (5%), mediastinal emphysema in 3/41 (7%), a life threatening nasopharyngeal hemorrhage and need for resuscitation during intubation in 5/41 (12%) NIV-episodes.
  
  
  CONCLUSIONS
  The prognosis of ARF in immunocompromised children remains guarded independent of initial success or failure of NIV due to a high rate of recurrent ARF. Reversible causes like bacterial sepsis had a higher NIV response rate. Relevant side effects of NIV were observed.
authors: Department of Neonatology and Pediatric Critical Care, Center for Pediatrics, Freiburg, Germany.
authors: H
authors: H
authors: Fuchs
authors: Division of Neonatology and Pediatric Critical Care, University Medical Center Ulm, Germany.
authors: J
authors: J
authors: Schoss
authors: Division of Neonatology and Pediatric Critical Care, University Medical Center Ulm, Germany.
authors: M R
authors: MR
authors: Mendler
authors: Division of Neonatology and Pediatric Critical Care, University Medical Center Ulm, Germany.
authors: W
authors: W
authors: Lindner
authors: Division of Neonatology and Pediatric Critical Care, University Medical Center Ulm, Germany.
authors: R
authors: R
authors: Hopfner
authors: Department of Oncology and Stem Cell Transplantation, University Medical Center Ulm, Germany.
authors: A
authors: A
authors: Schulz
authors: Department of Oncology and Stem Cell Transplantation, University Medical Center Ulm, Germany.
authors: M
authors: M
authors: Hoenig
authors: Department of Oncology and Stem Cell Transplantation, University Medical Center Ulm, Germany.
authors: D
authors: D
authors: Steinbach
authors: Department of Oncology and Stem Cell Transplantation, University Medical Center Ulm, Germany.
authors: K-M
authors: KM
authors: Debatin
authors: Division of Neonatology and Pediatric Critical Care, University Medical Center Ulm, Germany.
authors: H D
authors: HD
authors: Hummler
authors: Division of Neonatology and Pediatric Critical Care, University Medical Center Ulm, Germany.
authors: M
authors: M
authors: Schmid
mesh_terms: D000208:Acute Disease; D002648:Child; D002675:Child, Preschool; D005260:Female; D005858:Germany; D017052:Hospital Mortality; D006801:Humans; D016867:Immunocompromised Host / Q000276:immunology*; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D063087:Noninvasive Ventilation; D010359:Patient Readmission; D011379:Prognosis; D012008:Recurrence; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000276:immunology* / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000209:etiology / Q000401:mortality / Q000628:therapy; D015996:Survival Rate; D016896:Treatment Outcome