Efficacy and Predictors of Success of Noninvasive Ventilation for Prevention of Extubation Failure in Critically Ill Children With Heart Disease

摘要: The study aimed primarily to evaluate the efficacy of noninvasive ventilation (NIV) and identify possible predictors for success NIV therapy in preventing extubation failure critically ill children with heart disease. secondary objectives this were assess prophylactic initiated immediately after tracheal determine characteristics, outcomes, complications associated pediatric cardiac patients. A retrospective review examined medical records all between ages 1 day 18 years who sustained acute respiratory (ARF) that required cardiovascular intensive care unit (CVICU) at Lucile Packard Children's Hospital January 2008 June 2010. Patients assigned a group if was started directly nonprophylactic signs symptoms ARF developed. designated as responders they received did not require reintubation during their CVICU stay nonresponders failed performed. data collected included demographic data, preexisting conditions, pre-event event outcome data. evaluated or NIV, duration length (LOS), hospital LOS, mortality. two assessed nasal bridge forehead skin necrosis pneumothorax. 221 eligible events period involved 172 (77.8 %) 49 (22.2 %). total 201 experienced by cohort continuous positive airway pressure (CPAP), 156 (78 %), whereas 20 bilevel (BiPAP), 16 (80 In study, 58 (26.3 163 (73.7 group. Compared group, significantly shorter LOS (median, vs 88 days; p = 0.03) 60 103 0.05). differ (p 0.56) 0.88). Significant variables identifying responder lower risk-adjusted classification congenital surgery (RACHS-1) score (1-3), good left ventricular ejection fraction, normal rate (RR), appropriate oxygen saturation, therapeutic glucocorticoid within 24 h initiation, presence atelectasis, fewer than organ system dysfunctions, days intubation before extubation, no clinical microbiologic evidence sepsis, history reactive As well-tolerated therapy, can be safely successfully applied disease prevent failure. independent include RACHS-1 classification, steroid saturations demonstrated initiation NIV.