• Marco Piastra, Laura Marzano, Eleonora Stival, and Orazio Genovese.
• Paediatric Intensive Care Unit, Department of Anaesthesiology and Intensive Care University Hospital A. Gemelli, Catholic University of the Sacred Heart, L.go A. Gemelli 8, 00168 Rome, Italy.
• Intensive Care Med. 2011 Sep 1;37(9):1510-6.

PurposeNon-invasive positive pressure ventilation (NIV) is being increasingly used in paediatric critical care, although its use in acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) is still debated. No definite data are available for the prediction of NIV outcome in such selected populations. We aimed to identify which factors might affect NIV failure in paediatric ALI/ARDS patients.MethodsA retrospective cohort study using comprehensive predictivity analysis was performed. All children admitted to our paediatric intensive care unit over a 4-year period for ALI/ARDS were reviewed. Basic, clinical, physiological parameters and their change after 1 h of NIV were considered and subjected to univariate analysis. Candidate prognostic variables were then subjected to multicollinearity scrutiny and logistic regression. Finally, variables significant in the logistic regression were subjected to predictivity analysis.ResultsThe number of organ failures at admission (NOF) is a strong predictor of NIV failure (odds ratio 5.26; p = 0.004). Having only one organ failure provides a probability of NIV success of 85.7% (sensitivity 87%; specificity 49%). One NIV failure will be predicted and avoided for every four cases in which the presence of other organ failures is incorporated into the clinical decision.ConclusionsNOF significantly predicts the NIV failure. Children with no organ failures other than ALI/ARDS may safely be treated with NIV.

22 keywords...

hide…