Risk factors for failure of bilevel noninvasive mechanical ventilation in pediatric patients under one year of age with acute hypoxemic respiratory failure
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Abstract
Objective: The purpose of this study is to describe the characteristics of patients under one year of age with a diagnosis of acute hypoxemic respiratory failure (AHRF) who received initial noninvasive mechanical ventilation (NIV), to compare the evolution between those who succeeded and those who failed, and to identify possible factors of failure in this population.
Methods: Retrospective observational cohort study. All patients under one year of age with a diagnosis of ARF who required NIMV were included.
Results: 176 subjects with a median age of 4 (RIQ 2-7) months and 6 (RIQ 5-7.7) kilos were analyzed, of which 77 (37%) had a complex chronic condition. Bronchiolitis was diagnosed in 163 (93%) and pneumonia in the rest. Four children died (2%). Intubation was avoided in 102 (58%) patients. More than half of the failures occurred within the first 12 hours (59.5%). Patients who responded successfully to NIV had a shorter stay in both intensive care and hospital. The risk factors found were: symptom onset greater than 2 days; a modified Tal score value > 10 and a PIM 3 value equal to or greater than 0.6.
Conclusion: The use of synchronized noninvasive mechanical ventilation in patients with acute hypoxemic respiratory failure in children under one year of age is feasible. The evolution of the disease and the severity at hospital admission could characterize a population that is difficult to approach, with a considerable potential for success.
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