title: Efficacy of noninvasive mechanical ventilation in prevention of intubation and reintubation in the pediatric intensive care unit.
abstract: OBJECTIVE
  To determine the efficiency of noninvasive mechanical ventilation (NIV) both in protection from intubation and in preventing reintubation of postextubation in patients in the pediatric intensive care unit (PICU).
  
  
  METHODS
  A prospective observational study was conducted in a multidisciplinary 10-bed tertiary PICU of a university hospital. All patients were admitted to our unit from June 2012 to May 2014 and deemed to be candidates to receive continuous positive airway pressure or bilevel positive airway pressure.
  
  
  RESULTS
  We performed 160 NIV episodes in 137 patients. Their median age was 9 months (range, 1-240 months), and their median weight was 7.5 kg (range, 2.5-65 kg). Fifty-seven percent of patients were male. Noninvasive mechanical ventilation was successful in 70% (112 episodes) of patients. There was an underlying illness in 83.8% (134 episodes) of the patients. Bilevel positive airway pressure support was given to 57.5% (92 episodes) of the patients, whereas the remaining 42.5% (68 episodes) received continuous positive airway pressure support. Among the causes of respiratory failure in our patients, the most frequent were postextubation, pneumonia, bronchiolitis, atelectasia, and cardiogenic pulmonary edema. Sedation was applied in 43.1% of the episodes. Complications were detected in 29 episodes (18.1 %). The NIV failure group showed higher Pediatric Risk of Mortality III-24 score, shorter NIV duration, more frequent underlying disease, lower number fed, longer length of PICU stay, and hospital stay, and mortality was higher.
  
  
  CONCLUSIONS
  Noninvasive mechanical ventilation effectively and reliably reduced endotracheal intubation in the treatment of respiratory failure due to different clinical situations. Our results suggest that NIV can play an important role in PICUs in helping to avoid intubation and prevent reintubation. Although there were serious underlying diseases in most of our patients, such as immunosuppression, 70% avoided intubation with use of NIV.
authors.affiliation: Divisions of Pediatric Intensive Care Unit, Ankara University School of Medicine, Ankara, Turkey. Electronic address: dryamanayhan@yahoo.com.tr.
authors.forename: Ayhan
authors.initials: A
authors.lastname: Yaman
authors.affiliation: Divisions of Pediatric Intensive Care Unit, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Tanıl
authors.initials: T
authors.lastname: Kendirli
authors.affiliation: Divisions of Pediatric Intensive Care Unit, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Çağlar
authors.initials: Ç
authors.lastname: Ödek
authors.affiliation: Department of Biostatistics, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Can
authors.initials: C
authors.lastname: Ateş
authors.affiliation: Divisions of Pediatric Intensive Care Unit, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Nevin
authors.initials: N
authors.lastname: Taşyapar
authors.affiliation: Divisions of Pediatric Intensive Care Unit, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Melek
authors.initials: M
authors.lastname: Güneş
authors.affiliation: Divisions of Pediatric Intensive Care Unit, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Erdal
authors.initials: E
authors.lastname: İnce
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D045422:Continuous Positive Airway Pressure; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods*; D012131:Respiratory Insufficiency / Q000628:therapy*; D013997:Time Factors; D055815:Young Adult
keywords: Acute respiratory failure; Children; Intubation; Noninvasive mechanical ventilation; Pediatric intensive care unit; Reintubation