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Feasibility of non-invasive pressure support ventilation in infants with respiratory failure after extubation: a
Pascal Stucki1, Marie-Hélène Perez, Pietro Scalfaro
1Pediatric Intensive Care Unit, Centre Hospitalier Universitaire Vaudois, CHUV BH-05, 1011 Lausanne, Switzerland. dr.p.stucki@bluewin.ch
Objective:
To evaluate the feasibility and effects of non-invasive pressure support ventilation (NIV) on the breathing pattern in infants developing respiratory failure after extubation.
Design:
Prospective pilot clinical study; each patient served as their own control.
Setting:
A nine-bed paediatric intensive care unit of a tertiary university hospital.
Patients:
Six patients (median age 5 months, range 0.5-7 months; median weight 4.2 kg, range 3.8-5.1 kg) who developed respiratory failure after extubation.
Interventions:
After a period of spontaneous breathing (SB), children who developed respiratory failure were treated with NIV.
Measurements And Results:
Measurements included clinical dyspnoea score (DS), blood gases and oesophageal pressure recordings, which were analysed for respiratory rate (RR), oesophageal inspiratory pressure swing (dPes) and oesophageal pressure-time product (PTPes). All data were collected during both periods (SB and NIV). When comparing NIV with SB, DS was reduced by 44% (P < 0.001), RR by 32% (P < 0.001), dPes by 45% (P < 0.01) and PTPes by 57% (P < 0.001). A non-significant trend for decrease in PaCO(2) was observed.
Conclusion:
In these infants, non-invasive pressure support ventilation with turbine flow generator induced a reduction of breathing frequency, dPes and PTPes, indicating reduced load of the inspiratory muscles. NIV can be used with some benefits in infants with respiratory failure after extubation.
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