Sergio Menéndez

Non-invasive ventilation in pediatric status asthmaticus: A prospective observational study†‡

Non‐invasive ventilation (NIV) has been shown to be effective in different causes of respiratory failure in both adult and pediatric patients. However, its role in status asthmaticus (SA) remains unclear. We designed a prospective study to assess the feasibility of NIV in children with SA.

Helmet-delivered continuous positive airway pressure with heliox in respiratory syncytial virus bronchiolitis.

Aim:  The objective of this study was to check the feasibility and efficacy of helmet‐delivered heliox‐continuous positive airway pressure (CPAP) in infants with bronchiolitis.

Non invasive ventilation after extubation in paediatric patients: a preliminary study

BackgroundNon-invasive ventilation (NIV) may be useful after extubation in children. Our objective was to determine postextubation NIV characteristics and to identify risk factors of postextubation NIV failure.MethodsA prospective observational study was conducted in an 8-bed pediatric intensive care unit (PICU). Following PICU protocol, NIV was applied to patients who had been mechanically ventilated for over 12 hours considered at high-risk of extubation failure -elective NIV (eNIV), immediately after extubation- or those who developed respiratory failure within 48 hours after extubation -rescue NIV (rNIV)-. Patients were categorized in subgroups according to their main underlying conditions. NIV was deemed successful when reintubation was avoided. Logistic regression analysis was performed in order to identify predictors of NIV failure.ResultsThere were 41 episodes (rNIV in 20 episodes). Success rate was 50% in rNIV and 81% in eNIV (p = 0.037). We found significant differences in univariate analysis between success and failure groups in respiratory rate (RR) decrease at 6 hours, FiO2 at 1 hour and PO2/FiO2 ratio at 6 hours. Neurologic condition was found to be associated with NIV failure. Multiple logistic regression analysis identified no variable as independent NIV outcome predictor.ConclusionsOur data suggest that postextubation NIV seems to be useful in avoiding reintubation in high-risk children when applied immediately after extubation. NIV was more likely to fail when ARF has already developed (rNIV), when RR at 6 hours did not decrease and if oxygen requirements increased. Neurologic patients seem to be at higher risk of reintubation despite NIV use.

Correlation of oxygen saturation as measured by pulse oximetry/fraction of inspired oxygen ratio with Pao2/fraction of inspired oxygen ratio in a heterogeneous sample of critically ill children.

PURPOSE Oxygen saturation as measured by pulse oximetry (Spo2)/fraction of inspired oxygen (Fio2) (SF) ratio has demonstrated to be an adequate marker for lung disease severity in children under mechanical ventilation. We sought to validate the utility of SF ratio in a population of critically ill children under mechanical ventilation, noninvasive ventilation support, and breathing spontaneously. MATERIALS AND METHODS A retrospective database study was conducted in a pediatric intensive care unit of a university hospital. Children with Spo2 less than or equal to 97% and an indwelling arterial catheter were included. Simultaneous blood gas and pulse oximetry were collected in a database. Derivation and validation data sets were generated, and a linear mixed modeling was used to derive predictive equations. Model performance and fit were evaluated using the validation data set. RESULTS Three thousand two hundred forty-eight blood gas and Spo2 values from 298 patients were included. 1/SF ratio had a strong linear association with 1/Pao2/Fio2 (PF) ratio in both derivation and validation data sets, given by the equation 1/SF = 0.00164 + 0.521/PF (derivation). Oxygen saturation as measured by pulse oximetry/Fio2 values for PF criteria of 100, 200, and 300 were 146 (95% confidence interval [CI], 142-150), 236 (95% CI, 228-244), and 296 (95% CI, 285-308). Areas under receiver operating characteristic curves for diagnosis of PF ratio less than 100, 200, and 300 with the SF ratio were 0.978, 0.952, and 0.951, respectively, in the validation data set. CONCLUSIONS Oxygen saturation as measured by pulse oximetry/Fio2 ratio is an adequate noninvasive surrogate marker for PF ratio. Oxygen saturation as measured by pulse oximetry/Fio2 ratio may be an ideal noninvasive marker for patients with acute hypoxemic respiratory failure.

86 Nasal Continuous Airway Pressure Versus Helmet Continuous Airway Pressure in Infants with Bronchiolitis: A Crossover Study

Objective: To compare the efficacy and safety of CPAP delivered by helmet interface (HI) and CPAP delivered by Infant-Flow® system (IF) with nasal prongs. Methods: Prospective crossover study including infants 0.05). No adverse effects were recorded during the crossover period; later, two patients required intubation: one belonged to IF group and the other one to HI group. Conclusions: HI-CPAP was as effective as IF-CPAP in infants with acute bronchiolitis. Safety of both systems seems to be similar.

511 Non Invasive Ventilation in Pediatric Status Asthmaticus: A Prospective Observational Study

511 Non Invasive Ventilation in Pediatric Status Asthmaticus: A Prospective Observational Study