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Noninvasive pressure-support ventilation in immunocompromised children with ARDS: a feasibility study
Marco Piastra1, Daniele De Luca, Domenico Pietrini
1Pediatric Intensive Care Unit, Department of Anaesthesiology and Intensive Care, Catholic University of the Sacred Heart, University Hospital A.Gemelli, L.go A. Gemelli 8, 00168 Rome, Italy.
Intensive Care Medicine
|June 24, 2009
Summary
Non-invasive ventilation (NIV) is feasible for immunocompromised children with acute respiratory distress syndrome (ARDS). A short trial can assess its usefulness, but further trials are needed to confirm efficacy.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Medicine
- Immunocompromised Host Research
Background:
- Acute Respiratory Distress Syndrome (ARDS) poses significant risks to immunocompromised children.
- Non-invasive ventilation (NIV) is a potential alternative to invasive mechanical ventilation for pediatric ARDS.
- Feasibility and outcomes of NIV in this specific vulnerable population require investigation.
Purpose of the Study:
- To assess the feasibility and tolerance of Non-invasive Ventilation (NIV) in immunocompromised children diagnosed with Acute Respiratory Distress Syndrome (ARDS).
- To evaluate the effectiveness of NIV in improving respiratory parameters and patient outcomes in this cohort.
- To determine if a short NIV trial can predict treatment success.
Main Methods:
- A prospective study conducted in a University Hospital Pediatric Intensive Care Unit (PICU).
- Twenty-three immunocompromised children with ARDS received NIV via face-mask or helmet.
- Data on admission, severity scores, respiratory parameters (PaO2/FiO2 ratio, heart rate, respiratory rate), intubation rates, and mortality were collected.
Main Results:
- NIV was feasible and well-tolerated, with 82% showing early and 74% sustained improvement in PaO2/FiO2 ratio.
- 54.5% of patients avoided intubation and were discharged from the PICU.
- NIV non-responders experienced significantly higher PICU and in-hospital mortality, and longer PICU stays compared to responders.
Conclusions:
- Non-invasive ventilation (NIV) is a feasible and well-tolerated treatment option for immunocompromised children with ARDS.
- A brief NIV trial can help ascertain the technique's utility in this patient group.
- Randomized controlled trials are necessary to definitively establish the efficacy of NIV for ARDS in immunocompromised children.
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