• Medicina intensiva · Nov 2019

    Safety of aerosol therapy in children during noninvasive ventilation with helmet and total face mask.

    • L Rodriguez Garcia, A Medina, V Modesto I Alapont, M L Palacios Loro, J Mayordomo-Colunga, A Vivanco-Allende, and C Rey.
    • Paediatric Intensive Care Unit, Department of Paediatrics, Complejo Asistencial Universitario de León, León, Spain. Electronic address: luciarodrigar@gmail.com.
    • Med Intensiva. 2019 Nov 1; 43 (8): 474-479.

    PurposeTo evaluate the consequences of using nebulized drugs in patients subjected to noninvasive ventilation (NIV) with total face mask (TFM) and helmet.DesignA descriptive analytical study of a prospective patient cohort was carried out.AmbitPediatric intensive care unit (PICU) of a tertiary hospital.PatientsConsecutive sampling was used to include all patients admitted to the PICU and requiring NIV with helmet or TFM over a period of 29 months. No patients were excluded.InterventionsNebulized treatment was added according to medical criteria.Variables Of InterestIndependent variables were age, sex, diagnosis, disease severity, ventilation parameters and nebulized drugs (if administered). Secondary outcomes were duration and failure of NIV, and length of PICU stay.ResultsThe most frequent diagnoses were bronchiolitis (60.5%) and asthma (23%). Patients received NIV for a median of 43h. Nebulized drugs were administered in 40% of the cases during NIV, and no adverse effects were registered. Using Bayesian statistics, the calculated probability of suffering an adverse effect was 1.3% with helmet and 0.5% with TFM (high density 95% probability intervals). Patients with helmet and nebulized therapy were in more serious condition than those who did not receive nebulization; nevertheless, no differences were observed regarding the need to change to bilevel modality. With TFM, PICU stay was shorter for the same degree of severity (p=0.033), and the NIV failure rate was higher in patients who did not receive inhaled drugs (p=0.024).ConclusionsThe probability of suffering an adverse effect related to nebulization is extremely low when using a helmet or TFM. Inhaled therapy with TFM may shorten PICU stay in some patients.Copyright © 2018 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

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