• Andrea Wolfler, Edoardo Calderini, Elisa Iannella, Giorgio Conti, Paolo Biban, Anna Dolcini, Nicola Pirozzi, Fabrizio Racca, Andrea Pettenazzo, Ida Salvo, and Network of Pediatric Intensive Care Unit Study Group.
• 1Department of Anesthesia and Intensive Care, Children's Hospital V Buzzi, Milan, Italy. 2Department of Anesthesia and Intensive Care, Fondazione IRCCS Ca Granda, Ospedale Maggiore Policlinico, Milan, Italy. 3Department of Pediatric Anesthesia and Intensive Care, Ospedale Sant'Orsola Malpighi, Bologna, Italy. 4Pediatric ICU, Anesthesia and Intensive Care Department, Policlinico Universitario A.Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy. 5Department of Neonatal and Paediatric Intensive Care, Azienda Ospedaliera Universitaria Integrata, Verona, Italy. 6Department of Anesthesia and Intensive Care, Children's Hospital Santobono-Pausillipon, Napoli, Italy. 7Department of Anesthesia and Intensive Care, Children's Hospital Bambino Gesù, Rome, Italy 8Department of Anesthesia and Intensive Care, Children's Hospital Sant'Antonio e Biagio e Cesare Arrigo, Alessandria, Italy. 9Pediatric ICU, Pediatric Department, Ospedale Civile, Padova, Italy.
• Pediatr Crit Care Me. 2015 Jun 1;16(5):418-27.

ObjectiveTo assess how clinical practice of noninvasive ventilation has evolved in the Italian PICUs.DesignNational, multicentre, retrospective, observational cohort.SettingThirteen Italian medical/surgical PICUs that participated in the Italian PICU Network.PatientsSeven thousand one-hundred eleven admissions of children with 0-16 years old admitted from January 1, 2011, to December 31, 2012.InterventionsNone.Measurements And Main ResultsCause of respiratory failure, length and mode of noninvasive ventilation, type of interfaces, incidence of treatment failure, and outcome were recorded. Data were compared with an historical cohort of children enrolled along 6 months from November 1, 2006, to April 30, 2007, over the viral respiratory season. Seven thousand one-hundred eleven PICU admissions were analyzed, and an overall noninvasive ventilation use of 8.8% (n = 630) was observed. Among children who were admitted in the PICU without mechanical ventilation (n = 3,819), noninvasive ventilation was used in 585 patients (15.3%) with a significant increment among the three study years (from 11.6% in 2006 to 18.2% in 2012). In the endotracheally intubated group, 17.2% children received noninvasive ventilation at the end of the weaning process to avoid reintubation: 11.9% in 2006, 15.3% in 2011, and 21.6% in 2012. Noninvasive ventilation failure rate raised from 10% in 2006 to 16.1% in 2012.ConclusionsNoninvasive ventilation is increasingly and successfully used as first respiratory approach in several, but not all, Italian PICUs. The current study shows that noninvasive ventilation represents a feasible and safe technique of ventilatory assistance for the treatment of mild acute respiratory failure. Noninvasive ventilation was used as primary mode of ventilation in children with low respiratory tract infection (mainly in bronchiolitis and pneumonia), in acute on chronic respiratory failure or to prevent reintubation.

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