Non invasive positive pressure ventilation in infants with respiratory failure

To determine whether non-invasive positive pressure ventilation (NIPPV) delivered via nasal prongs can alleviate the need for tracheal intubation and invasive ventilation in infants admitted to the pediatric intensive care unit (PICU) with impending respiratory failure, and to find predictive factors for success or failure with this mode.

A single center retrospective cohort study.

PICU in a university affiliated hospital.

During the 14 months of the study period we recovered 22 NIPPV episodes in 19 infants (median age 65 days) with impending respiratory failure. The patient's respiratory failure etiologies were bronchiolitis (n = 13), pertussis (n = 3), and other respiratory conditions (n = 6).

In 64% of the cases, intubation was prevented and the patients were weaned off to spontaneous breathing (Responders group). 36% failed NIPPV and had to be intubated and invasively ventilated (Non-responders group). Apneic episodes were the indication for ventilation in 11 patients (50%) with a 73% success rate in preventing invasive ventilation. Hypoxemic respiratory failure was present in nine patients (41%) and the rate of success was 44%. Two patients with post extubation respiratory distress, improved with NIPPV. Responders and non-responders did not differ with regard to demographics or disease severity prior to initiation of NIPPV. After initiating NIPPV respiratory rate and the need for sedation were lower in the NIPPV responders.

In a set group of patient population such as infants with apnea secondary to bronchiolitis NIPPV may be successful to reduce the need for invasive ventilation. Our study failed to detect any physiological or clinical markers which could distinguish between so called "responders" and "non-responders" before initiating NIPPV.