The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

ROLE OF NONINVASIVE POSITIVE PRESSURE VENTILATION IN PREVENTING EXTUBATION FAILURE IN THE PEDIATRIC CRITICAL CARE SETTING.

Juan P. Bonora1, Gustavo Olguin1, Dardo Fracchia1, Ruben D. Restrepo2



Background: Noninvasive positive-pressure ventilation (NPPV) has been associated with a decreased in reintubation rates and lower mortality in critically ill adult patients at risk for developing postextubation respiratory failure. However, there is very limited data on this prophylactic role of NPPV in the pediatric critical care setting.

Objectives:
To assess the effectiveness of NPPV on reducing reintubation rates in a pediatric intensive care unit. Methods: Retrospective review of 24 pediatric patients admitted to the ICU who required invasive ventilatory support and met criteria consistent with higher risk for extubation failure between January and December of 2007. Clinical criteria included conditions such as diagnosis of ARDS, prolonged mechanical ventilation, prior history of extubation failure, chronic lung disease, and confirmed respiratory muscle weakness prior to extubation. Setting: A16-bed medical and surgical pediatric ICU at Hospital de Pediatria Dr. Juan P. Garrahan, a 500-bed hospital in Buenos Aires, Argentina. Interventions and Outcomes: Immediately after extubation, all patients were placed on NPPV plus supplemental oxygen. Time on invasive mechanical ventilation, time on NPPV, rate of reintubation and length of ICU stay were measured. Both responders and non-responders to NPPV after extubation were compared using student's t-test (SPSS 11.0).

Results:
Twenty one patients (87.5%) were extubated to NPPV and did not require reintubation whereas 12.5% did not respond to NPPV and required reintubation. The non-responders group had a tendency to be younger (p=0.23) and remained on NPPV a shorter period of time when compared to the responders (p=0.1). There was a significant difference between groups in terms of the number of days on invasive ventilation prior to extubation (p=0.006) and the lenght of ICU stay (p=0.007).

Conclusions:
The use of NPPV resulted in a considerable reduction of extubation failure in these pediatric patients at risk for reintubation. Although the use of NPPV was associated with a significant decrease in the ICU stay, this finding was greatly influenced by the time on invasive mechanical ventilation prior to extubation. NPPV may play an important role in preventing intubation in pediatric patients at risk for extubation failure.