• OngunEbru AtikeEA0000-0002-1248-8635Department of Pediatrics, Division of Pediatric Critical Care, Faculty of Medicine, Akdeniz University Antalya, Turkey, Oğuz Dursun, Ayşe Berna Anıl, Ümit Altuğ, Özlem Temel Köksoy, Başak Nur Akyıldız, Serkan Özsoylu, Tanıl Kendirli, Serhan Özcan, Rıza Dinçer Yıldızdaş, İlknur Tolunay, Bülent Karapınar, Mehmet Arda Kılınç, and Demet Demirkol.
• Department of Pediatrics, Division of Pediatric Critical Care, Faculty of Medicine, Akdeniz University Antalya, Turkey
• Turk J Med Sci. 2021 Jun 28; 51 (3): 115911711159-1171.

Background/AimTo characterize the clinical course of noninvasive positive pressure ventilation (NIPPV) and high flow humidified nasal cannula ventilation (HFNC) procedures; perform risk analysis for ventilation failure.Material And MethodsThis prospective, multi-centered, observational study was conducted in 352 PICU admissions (1 month-18 years) between 2016 and 2017. SPSS-22 was used to assess clinical data, define thresholds for ventilation parameters and perform risk analysis.ResultsPatient age, onset of disease, previous intubation and hypoxia influenced the choice of therapy mode: NIPPV was preferred in older children (p = 0.002) with longer intubation (p < 0.001), ARDS (p = 0.001), lower respiratory tract infections (p < 0.001), chronic respiratory disease, (p = 0.005), malignancy (p = 0.048) and immune deficiency (p = 0.026). The failure rate was 13.4%. sepsis, ARDS, prolonged intubation, and use of nasal masks were associated with NIV failure (p = 0.001, p < 0.001, p < 0.001, p = 0.025). The call of intubation or re-intubation was given due to respiratory failure in twenty-seven (57.5%), hemodynamic instability in eight (17%), bulbar dysfunction or aspiration in 5 (10.6%), neurological deterioration in 4 (8.5%) and developing ARDS in 3 (6.4%) children. A reduction of less than 10% in the respiration within an hour increased the odds of failure by 9.841 times (OR: 9.841, 95% CI: 2.0021–48.3742). FiO2 > 55% at 6th hours and PRISM-3 >8 were other failure predictors. Of the 9.9% complication rate, the most common complication was pressure ulcerations (4.8%) and mainly observed when using full-face masks (p = 0.047). Fifteen (4.3%) patients died of miscellaneous causes. Tracheostomy cannulation was performed on 16 children due to prolonged mechanical ventilation (8% in NIPPV, 2.6% in HFNC)ConclusionAbsence of reduction in the respiration rate within an hour, FiO2 requirement >55% at 6th hours and PRISM-3 score >8 predict NIV failure.This work is licensed under a Creative Commons Attribution 4.0 International License.

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