• Ann Acad Med Singap · Jul 2019

    Non-Invasive Ventilation in Children with Paediatric Acute Respiratory Distress Syndrome.

    • Jian Sheng Zeng, Su Yun Qian, Judith Jm Wong, Jacqueline Sm Ong, Chin Seng Gan, Nattachai Anantasit, Yek Kee Chor, Rujipat Samransamruajkit, Phan Huu Phuc, Suwannee Phumeetham, Xu Feng, Rehena Sultana, Tsee Foong Loh, and Jan Hau Lee.
    • Children's Intensive Care Unit, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore.
    • Ann Acad Med Singap. 2019 Jul 1; 48 (7): 224-232.

    IntroductionEvidence supporting non-invasive ventilation (NIV) in paediatric acute respiratory distress syndrome (PARDS) remains sparse. We aimed to describe characteristics of patients with PARDS supported with NIV and risk factors for NIV failure.Materials And MethodsThis is a multicentre retrospective study. Only patients supported on NIV with PARDS were included. Data on epidemiology and clinical outcomes were collected. Primary outcome was NIV failure which was defined as escalation to invasive mechanical ventilation within the first 7 days of PARDS. Patients in the NIV success and failure groups were compared.ResultsThere were 303 patients with PARDS; 53/303 (17.5%) patients were supported with NIV. The median age was 50.7 (interquartile range: 15.7-111.9) months. The Paediatric Logistic Organ Dysfunction score and oxygen saturation/fraction of inspired oxygen (SF) ratio were 2.0 (1.0-10.0) and 155.0 (119.4- 187.3), respectively. Indications for NIV use were increased work of breathing (26/53 [49.1%]) and hypoxia (22/53 [41.5%]). Overall NIV failure rate was 77.4% (41/53). All patients with sepsis who developed PARDS experienced NIV failure. NIV failure was associated with an increased median paediatric intensive care unit stay (15.0 [9.5-26.5] vs 4.5 [3.0-6.8] days; P <0.001) and hospital length of stay (26.0 [17.0-39.0] days vs 10.5 [5.5-22.3] days; P = 0.004). Overall mortality rate was 32.1% (17/53).ConclusionThe use of NIV in children with PARDS was associated with high failure rate. As such, future studies should examine the optimal selection criteria for NIV use in these children.

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