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Evolution of Noninvasive Mechanical Ventilation Use: A Cohort Study Among Italian PICUs
Andrea Wolfler1, Edoardo Calderini, Elisa Iannella
11Department of Anesthesia and Intensive Care, Children's Hospital V Buzzi, Milan, Italy. 2Department of Anesthesia and Intensive Care, Fondazione IRCCS Ca Granda, Ospedale Maggiore Policlinico, Milan, Italy. 3Department of Pediatric Anesthesia and Intensive Care, Ospedale Sant'Orsola Malpighi, Bologna, Italy. 4Pediatric ICU, Anesthesia and Intensive Care Department, Policlinico Universitario A.Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy. 5Department of Neonatal and Paediatric Intensive Care, Azienda Ospedaliera Universitaria Integrata, Verona, Italy. 6Department of Anesthesia and Intensive Care, Children's Hospital Santobono-Pausillipon, Napoli, Italy. 7Department of Anesthesia and Intensive Care, Children's Hospital Bambino Gesù, Rome, Italy 8Department of Anesthesia and Intensive Care, Children's Hospital Sant'Antonio e Biagio e Cesare Arrigo, Alessandria, Italy. 9Pediatric ICU, Pediatric Department, Ospedale Civile, Padova, Italy.
Insights
Noninvasive ventilation (NIV) use in Italian pediatric intensive care units (PICUs) has increased significantly. NIV is a safe and feasible approach for mild respiratory failure, particularly for infections and preventing reintubation.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Physiology
- Mechanical Ventilation
Background:
- Noninvasive ventilation (NIV) is a crucial respiratory support method in pediatric intensive care units (PICUs).
- Understanding the evolution of NIV clinical practice is essential for optimizing patient outcomes.
Purpose of the Study:
- To evaluate trends in the clinical application of noninvasive ventilation in Italian PICUs.
- To compare current NIV practices with historical data.
Main Methods:
- A national, multicenter, retrospective, observational cohort study.
- Analysis of 7,111 admissions in 13 Italian PICUs between 2011 and 2012.
- Comparison with a historical cohort from 2006-2007.
Main Results:
- Overall NIV use was 8.8%, with a significant increase from 11.6% (2006) to 18.2% (2012) as a primary treatment for respiratory failure.
- NIV use to prevent reintubation in intubated patients rose from 11.9% (2006) to 21.6% (2012).
- The NIV failure rate increased from 10% in 2006 to 16.1% in 2012.
Conclusions:
- Noninvasive ventilation is increasingly utilized as a primary respiratory intervention in Italian PICUs.
- NIV is a feasible and safe method for managing mild acute respiratory failure, including respiratory infections and preventing reintubation.
- Variability in NIV adoption exists across different Italian PICUs.
Objective:
To assess how clinical practice of noninvasive ventilation has evolved in the Italian PICUs.
Design:
National, multicentre, retrospective, observational cohort.
Setting:
Thirteen Italian medical/surgical PICUs that participated in the Italian PICU Network.
Patients:
Seven thousand one-hundred eleven admissions of children with 0-16 years old admitted from January 1, 2011, to December 31, 2012.
Interventions:
None.
Measurements And Main Results:
Cause of respiratory failure, length and mode of noninvasive ventilation, type of interfaces, incidence of treatment failure, and outcome were recorded. Data were compared with an historical cohort of children enrolled along 6 months from November 1, 2006, to April 30, 2007, over the viral respiratory season. Seven thousand one-hundred eleven PICU admissions were analyzed, and an overall noninvasive ventilation use of 8.8% (n = 630) was observed. Among children who were admitted in the PICU without mechanical ventilation (n = 3,819), noninvasive ventilation was used in 585 patients (15.3%) with a significant increment among the three study years (from 11.6% in 2006 to 18.2% in 2012). In the endotracheally intubated group, 17.2% children received noninvasive ventilation at the end of the weaning process to avoid reintubation: 11.9% in 2006, 15.3% in 2011, and 21.6% in 2012. Noninvasive ventilation failure rate raised from 10% in 2006 to 16.1% in 2012.
Conclusions:
Noninvasive ventilation is increasingly and successfully used as first respiratory approach in several, but not all, Italian PICUs. The current study shows that noninvasive ventilation represents a feasible and safe technique of ventilatory assistance for the treatment of mild acute respiratory failure. Noninvasive ventilation was used as primary mode of ventilation in children with low respiratory tract infection (mainly in bronchiolitis and pneumonia), in acute on chronic respiratory failure or to prevent reintubation.
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