Post Extubation Noninvasive Respiratory Support for Pediatric ARDS

Pediatric ARDS (PARDS) survivors may need postextubation noninvasive respiratory support (NRS) via high-flow nasal cannula, CPAP, or noninvasive ventilation (NIV). We hypothesized that NRS use post extubation would vary by region.

We performed a post-hoc analysis of the Pediatric Acute Respiratory Distress Incidence and Epidemiology (PARDIE) study and compared extubated subjects receiving NRS to those who did not. Logistic regression tested the associations between risk factors and post extubation NRS use.

We included 468 surviving subjects (median age: 2.2 [IQR: 0.5-8.7] years) of whom 262 (56%) received postextubation NRS. Subjects treated with NRS postextubation spent more time in the ICU (median: 13.7 [IQR: 8.3-24.5] vs 10.1 [IQR: 6.3-17.6] days, p < 0.01). Increasing age (OR: 0.95, 95% CI: 0.92-0.99), increasing PRISM4 (OR: 0.18, 95% CI: 0.04-0.85), and longer duration of invasive mechanical ventilation (OR: 0.98, 95% CI: 0.96-0.99) were associated with a decreased odds of postextubation NRS use. Being from the North American region (OR: 2.41, 95% CI: 1.26-4.68) compared to Central and South America, immunocompromised (OR: 2.45, 95% CI: 1.09-5.9), and neuromuscular disease (OR: 2.96, 95% CI: 1.51-6.1) were associated with an increased odds of postextubation NRS use. Increased HFNC use was associated with North American region and prior ECMO exposure while age, NRS before intubation, and duration of mechanical ventilation were associated with decreased use. NIV use was associated with European region, Middle East/Asia/New Zealand, neuromuscular disease, and beta agonist use.

Over half of PARDS subjects received post extubation NRS and type of use varied by region, comorbidities, age, and duration of mechanical ventilation. HFNC was more widely used in North America while NIV was used more in Europe, and the Middle East/Asia/New Zealand.