title: Evolution of Noninvasive Mechanical Ventilation Use: A Cohort Study Among Italian PICUs.
abstract: OBJECTIVE
  To assess how clinical practice of noninvasive ventilation has evolved in the Italian PICUs.
  
  
  METHODS
  National, multicentre, retrospective, observational cohort.
  
  
  METHODS
  Thirteen Italian medical/surgical PICUs that participated in the Italian PICU Network.
  
  
  METHODS
  Seven thousand one-hundred eleven admissions of children with 0-16 years old admitted from January 1, 2011, to December 31, 2012.
  
  
  METHODS
  None.
  
  
  RESULTS
  Cause of respiratory failure, length and mode of noninvasive ventilation, type of interfaces, incidence of treatment failure, and outcome were recorded. Data were compared with an historical cohort of children enrolled along 6 months from November 1, 2006, to April 30, 2007, over the viral respiratory season. Seven thousand one-hundred eleven PICU admissions were analyzed, and an overall noninvasive ventilation use of 8.8% (n = 630) was observed. Among children who were admitted in the PICU without mechanical ventilation (n = 3,819), noninvasive ventilation was used in 585 patients (15.3%) with a significant increment among the three study years (from 11.6% in 2006 to 18.2% in 2012). In the endotracheally intubated group, 17.2% children received noninvasive ventilation at the end of the weaning process to avoid reintubation: 11.9% in 2006, 15.3% in 2011, and 21.6% in 2012. Noninvasive ventilation failure rate raised from 10% in 2006 to 16.1% in 2012.
  
  
  CONCLUSIONS
  Noninvasive ventilation is increasingly and successfully used as first respiratory approach in several, but not all, Italian PICUs. The current study shows that noninvasive ventilation represents a feasible and safe technique of ventilatory assistance for the treatment of mild acute respiratory failure. Noninvasive ventilation was used as primary mode of ventilation in children with low respiratory tract infection (mainly in bronchiolitis and pneumonia), in acute on chronic respiratory failure or to prevent reintubation.
authors.affiliation: 1Department of Anesthesia and Intensive Care, Children's Hospital V Buzzi, Milan, Italy. 2Department of Anesthesia and Intensive Care, Fondazione IRCCS Ca Granda, Ospedale Maggiore Policlinico, Milan, Italy. 3Department of Pediatric Anesthesia and Intensive Care, Ospedale Sant'Orsola Malpighi, Bologna, Italy. 4Pediatric ICU, Anesthesia and Intensive Care Department, Policlinico Universitario A.Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy. 5Department of Neonatal and Paediatric Intensive Care, Azienda Ospedaliera Universitaria Integrata, Verona, Italy. 6Department of Anesthesia and Intensive Care, Children's Hospital Santobono-Pausillipon, Napoli, Italy. 7Department of Anesthesia and Intensive Care, Children's Hospital Bambino Gesù, Rome, Italy 8Department of Anesthesia and Intensive Care, Children's Hospital Sant'Antonio e Biagio e Cesare Arrigo, Alessandria, Italy. 9Pediatric ICU, Pediatric Department, Ospedale Civile, Padova, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Wolfler
authors.forename: Edoardo
authors.initials: E
authors.lastname: Calderini
authors.forename: Elisa
authors.initials: E
authors.lastname: Iannella
authors.forename: Giorgio
authors.initials: G
authors.lastname: Conti
authors.forename: Paolo
authors.initials: P
authors.lastname: Biban
authors.forename: Anna
authors.initials: A
authors.lastname: Dolcini
authors.forename: Nicola
authors.initials: N
authors.lastname: Pirozzi
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Racca
authors.forename: Andrea
authors.initials: A
authors.lastname: Pettenazzo
authors.forename: Ida
authors.initials: I
authors.lastname: Salvo
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D007558:Italy; D007902:Length of Stay; D008297:Male; D063087:Noninvasive Ventilation / Q000379:methods* / Q000706:statistics & numerical data*; D012121:Respiration, Artificial / Q000379:methods / Q000706:statistics & numerical data; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors