• H Fuchs, J Schoss, M R Mendler, W Lindner, R Hopfner, A Schulz, M Hoenig, D Steinbach, K-M Debatin, H D Hummler, and M Schmid.
• Department of Neonatology and Pediatric Critical Care, Center for Pediatrics, Freiburg, Germany.
• Klin Padiatr. 2015 Nov 1; 227 (6-7): 322-8.

BackgroundNoninvasive ventilation (NIV) may be superior to conventional therapy in immunocompromised children with respiratory failure.MethodsMortality, success rate, prognostic factors and side effects of NIV for acute respiratory failure (ARF) were investigated retrospectively in 41 in children with primary immunodeficiency, after stem cell transplantation or chemotherapy for oncologic disease.ResultsIn 11/41 (27%) children invasive ventilation was avoided and patients were discharged from ICU. In children with NIV failure ICU-mortality was 19/30 (63%). 8/11 (72%) children with NIV success had recurrence of ARF after 27 days. Only 4/11 (36%) children with first episode NIV success and 8/30 (27%) with NIV failure survived to hospital discharge. Lower FiO2, SpO2/FiO2 and blood culture positive bacterial sepsis were predictive for NIV success, while fungal sepsis or culture negative ARF were predictive for NIV failure. We observed catecholamine treatment in 14/41 (34%), pneumothorax in 2/41 (5%), mediastinal emphysema in 3/41 (7%), a life threatening nasopharyngeal hemorrhage and need for resuscitation during intubation in 5/41 (12%) NIV-episodes.ConclusionsThe prognosis of ARF in immunocompromised children remains guarded independent of initial success or failure of NIV due to a high rate of recurrent ARF. Reversible causes like bacterial sepsis had a higher NIV response rate. Relevant side effects of NIV were observed.© Georg Thieme Verlag KG Stuttgart · New York.

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