Retrospective Cohort Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Sep 7, 2018; 7(4): 46-51
Published online Sep 7, 2018. doi: 10.5492/wjccm.v7.i4.46
Clinical characteristics and outcomes associated with nasal intermittent mandatory ventilation in acute pediatric respiratory failure
Billy C Wang, Theodore Pei, Cheryl B Lin, Rong Guo, David Elashoff, James A Lin, Carol Pineda
Billy C Wang, Department of Pediatrics, Division of Critical Care Medicine, Loma Linda University Children’s Hospital, Loma Linda, CA 92354, United States
Theodore Pei, Cheryl B Lin, Carol Pineda, Department of Pediatrics, Division of Pediatric Critical Care, Floating Hospital for Children at Tufts, Boston, MA 02111, United States
Rong Guo, David Elashoff, Department of Medicine, Biostatistics Core, UCLA David Geffen School of Medicine, Los Angeles, CA 90024, United States
James A Lin, Department of Pediatrics, Mattel Children’s Hospital at UCLA, Los Angeles, CA 90095, United States
Author contributions: Wang BC, Pei T, Pineda C and Lin JA designed the study, collected data, and participated in writing and revision of the manuscript; Lin CB collected data and reviewed the manuscript; Guo R and Elashoff D provided statistical analysis and reviewed the manuscript
Supported by NIH National Center for Advancing Translational Science, No. UL1TR001881.
Institutional review board statement: This study was approved by the UCLA Institutional Review Board.
Conflict-of-interest statement: All authors have no conflicts of interest to report.
STROBE statement: The STROBE Statement have been adopted.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Billy C Wang, MD, Fellow, Department of Pediatrics, Division of Critical Care Medicine, Loma Linda University Children’s Hospital, 11234 Anderson Street Room CH5763, Loma Linda, CA 92354, United States. bcwang@llu.edu
Telephone: +1-909-5584250 Fax: +1-909-5580303
Received: June 2, 2018
Peer-review started: June 2, 2018
First decision: July 9, 2018
Revised: July 25, 2018
Accepted: August 4, 2018
Article in press: August 5, 2018
Published online: September 7, 2018
Processing time: 97 Days and 13.6 Hours
Abstract
AIM

To characterize the clinical course and outcomes of nasal intermittent mandatory ventilation (NIMV) use in acute pediatric respiratory failure.

METHODS

We identified all patients treated with NIMV in the pediatric intensive care unit (PICU) or inpatient general pediatrics between January 2013 and December 2015 at two academic centers. Patients who utilized NIMV with other modes of noninvasive ventilation during the same admission were included. Data included demographics, vital signs on admission and prior to initiation of NIMV, pediatric risk of mortality III (PRISM-III) scores, complications, respiratory support characteristics, PICU and hospital length of stays, duration of respiratory support, and complications. Patients who did not require escalation to mechanical ventilation were defined as NIMV responders; those who required escalation to mechanical ventilation (MV) were defined as NIMV non-responders. NIMV responders were compared to NIMV non-responders.

RESULTS

Forty-two patients met study criteria. Six (14%) failed treatment and required MV. The majority of the patients (74%) had a primary diagnosis of bronchiolitis. The median age of these 42 patients was 4 mo (range 0.5-28.1 mo, IQR 7, P = 0.69). No significant difference was measured in other baseline demographics and vitals on initiation of NIMV; these included age, temperature, respiratory rate, O2 saturation, heart rate, systolic blood pressure, diastolic blood pressure, and PRISM-III scores. The duration of NIMV was shorter in the NIMV non-responder vs NIMV responder group (6.5 h vs 65 h, P < 0.0005). Otherwise, NIMV failure was not associated with significant differences in PICU length of stay (LOS), hospital LOS, or total duration of respiratory support. No patients had aspiration pneumonia, pneumothorax, or skin breakdown.

CONCLUSION

Most of our patients responded to NIMV. NIMV failure is not associated with differences in hospital LOS, PICU LOS, or duration of respiratory support.

Keywords: Continuous positive airway pressure; Pediatric; Noninvasive positive pressure ventilation; Nasal intermittent mandatory ventilation; High flow nasal cannula; Acute respiratory failure; Bilevel positive airway pressure

Core tip: In our cohort of patients between 0.5 and 28.1 mo of age with acute respiratory failure, the majority of patients were successfully supported with nasal intermittent mandatory ventilation (NIMV) alone or NIMV in conjunction with other modes of noninvasive ventilation (NIV). Use of NIMV with or without NIV was not associated with significant differences in hospital length of stay (LOS), pediatric intensive care unit LOS, or duration of respiratory support. Failure of NIMV with or without NIV was recognized in a median of 6.5 h.