ABSTRACT
Objetivo En adultos el fracaso de la ventilación no invasiva (VNI) se ha asociado a peores resultados clínicos debido al retraso en la intubación y en el inicio de la ventilación invasiva (VMI). Existe falta de evidencia de esta asociación en pediatría. Nuestro objetivo fue determinar la asociación entre la duración de la VMI y la estancia, con la duración de la VNI previo a la intubación/VMI en pacientes pediátricos. Diseño Estudio de cohorte prospectivo desde enero de 2015 a octubre de 2019. Ámbito Unidad de cuidados intensivos pediátricos (UCIP). Pacientes Niños/as menores de 15años con insuficiencia respiratoria aguda (IRA) que fracasaron a la VNI. Intervenciones Ninguna. Variables de interés principales Se registraron variables demográficas y clínicas, índice de mortalidad pediátrica (PIM2), diagnóstico de síndrome de distrés respiratorio agudo pediátrico (SDRAP), duración de la VMI y la VNI, estancia en UCIP y mortalidad intrahospitalaria. Resultados Se incluyeron un total de 109 pacientes con una mediana de edad de 7 (3-14) meses. El diagnóstico principal fue neumonía (89,9%). El 37,6% de la muestra presentó SDRAP. No se encontró asociación entre duración de la VNI y duración de la VMI mediante el análisis de Kaplan-Meier (logrank test p=0,479). No se encontraron diferencias significativas entre la estancia en UCIP (p=0,253) y hospitalaria (p=0,669) al categorizar por duración de la VNI. El SDRAP se asoció a mayor duración de la VMI (HR: 0,64 [IC95%: 0,42-0,99]). Conclusión No se encontró asociación entre la duración de la VNI previo a la intubación y la duración de la VMI, ni en la estancia en pacientes pediátricos con IRA (AU)
Objective Noninvasive ventilation (NIV) failure it has been associated to worst clinical outcomes due to a delay in intubation and initiation of invasive mechanical ventilation (IMV). There is a lack of evidence in pediatric patients regarding this topic. The objective was to determine the association between duration of IMV and length of stay, with duration of NIV prior to intubation/IMV in pediatric patients. Design A prospective cohort study since January 2015 to October 2019. Setting A pediatric intensive care unit. Patients Children under 15years with acute respiratory failure who failed to noninvasive ventilation. Interventions None. Main variables of interest Demographic variables, pediatric index of mortality (PIM2), pediatric acute respiratory distress syndrome (PARDS) diagnosis, IMV and NIV duration, PICU LOS were registered and intrahospital mortality. Results A total of 109 patients with a median (IQR) age of 7 (3-14) months were included. The main diagnosis was pneumonia (89.9%). PARDS was diagnosed in 37.6% of the sample. No association was found between NIV duration and duration of IMV after Kaplan-Meier analysis (Log rank P=.479). There was no significant difference between PICU LOS (P=.253) or hospital LOS (P=0.669), when categorized by NIV duration before intubation. PARDS diagnosis was associated to an increased length of invasive ventilation (HR: 0.64 [95%IC: 0.42-0.99]). Conclusions No association was found between NIV duration prior to intubation and duration of invasive ventilation in critical pediatric patients with acute respiratory failure (AU)
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Respiration, Artificial/methods , Respiratory Insufficiency/therapy , Intubation, Intratracheal , Treatment Outcome , Prospective Studies , Cohort Studies , Time Factors , Acute DiseaseABSTRACT
OBJECTIVE: Noninvasive ventilation (NIV) failure it has been associated to worst clinical outcomes due to a delay in intubation and initiation of invasive mechanical ventilation (IMV). There is a lack of evidence in pediatric patients regarding this topic. The objective was to deter-mine the association between duration of IMV and length of stay, with duration of NIV prior tointubation/IMV in pediatric patients. DESIGN: A prospective cohort study since January 2015 to October 2019. SETTING: A pediatric intensive care unit. PATIENTS: Children under 15 years with acute respiratory failure who failed to noninvasive ventilation. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Demographic variables, pediatric index of mortality (PIM2), pediatric acute respiratory distress syndrome (PARDS) diagnosis, IMV and NIV duration, PICU LOS were registered and intrahospital mortality. RESULTS: A total of 109 patients with a median (IQR) age of 7 (3-14) months were included. The main diagnosis was pneumonia (89.9%). PARDS was diagnosed in 37.6% of the sample. No association was found between NIV duration and duration of IMV after Kaplan-Meier analysis (Log rank P = .479). There was no significant difference between PICU LOS (P = .253) or hospital LOS (P = 0.669), when categorized by NIV duration before intubation. PARDS diagnosis was associated to an increased length of invasive ventilation (HR: 0.64 [95% IC: 0.42-0.99]). CONCLUSIONS: No association was found between NIV duration prior to intubation and duration of invasive ventilation in critical pediatric patients with acute respiratory failure.
