2012 OPEN FORUM Abstracts
COMPARISON OF PEDIATRIC PATIENTS ADMITTED WITH ACUTE RESPIRATORY FAILURE WHO WERE TRIALED ON NON-INVASIVE VENTILATION VERSUS PATIENTS WHO WERE INTUBATED.
Michelle Lilley1, Karyn Reinhardt1, Chris Mullen1, John H. Arnold1,2; 1Respiratory Care, Boston Childrens Hospital, Boston, MA; 2Harvard Medical School, Boston, MA
Background: An assisted ventilation database allows us to identify trends in our practice and develop quality improvement projects. Non-invasive ventilation (NIV) use in pediatrics seems to be increasing as a first line treatment for respiratory distress. We report the use of NIV in patients with acute respiratory failure (ARF) in order to determine the differences in mortality and duration of ventilation between those patients who were trialed on NIV and those who were not. Method: A retrospective review was conducted using the database (MS Access) in patients admitted with ARF over a 1 year period. The admitting diagnosis, sex, device hours (hrs), NIV failures, outcome, and the reason for respiratory support were queried. The data was exported to Prism GraphPad for analysis. The Mann-Whitney U Test was used to compare ventilator hours between the two groups. The Fishers exact test was used to compare the survival to ICU discharge and patient sex. Results: There were 25 patients diagnosed with ARF (see Table). Overall, there were 12 patients (48%) trialed on NIV with a 100% failure rate. The mean duration of NIV prior to intubation was 7.9 hrs with a range of 1-33 hrs. The NIV group required HFOV more than the No-NIV group (83% vs. 62%). The NIV group had a longer duration of ventilation (P < 0.05). The survival to ICU discharge was worse in the NIV group (P < 0.05). The majority of NIV failures and deaths were oncology patients who tend to be our sickest ICU population. Conclusions: In a small cohort of patients, NIV support did not prevent intubation. These results indicate the need to identify variables that will help us differentiate those patients who require intubation from those who can be successfully managed on NIV. It is possible that the application of NIV is delaying intubation in those patients who have progressing lung disease. Sponsored Research - None Device hours are expressed as Median (interquartile range)