Predicting the success of non-invasive ventilation in preventing intubation and re-intubation in the paediatric intensive care unit
| Autor: | Dominique P. L. James, Christopher P. J. Hallewell, Quen Q. Mok, Angie Wade, Christopher S. James |
|---|---|
| Rok vydání: | 2011 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Respiratory rate medicine.medical_treatment Intensive Care Units Pediatric Critical Care and Intensive Care Medicine Positive-Pressure Respiration Risk Factors Anesthesiology Intubation Intratracheal medicine Humans Intubation Treatment Failure Child Retrospective Studies Mechanical ventilation Medical Audit business.industry Infant Retrospective cohort study Odds ratio United Kingdom Blood pressure Child Preschool Anesthesia Multivariate Analysis Breathing Female Respiratory Insufficiency business Ventilator Weaning Forecasting |
| Zdroj: | Intensive Care Medicine. 37:1994-2001 |
| ISSN: | 1432-1238 0342-4642 |
| Popis: | To determine whether physiological parameters and underlying condition can be used to predict which patients can be managed successfully on non-invasive ventilation (NIV). Review of case notes and computerised data of every paediatric intensive care unit (PICU) admission over 7 years where NIV was commenced. Data immediately prior to commencing NIV and 2 h after its establishment was collected. Univariable and multivariable statistical analysis was performed to compare variables. Eighty-three patients commenced NIV attempting to avoid intubation and 64% succeeded. Those who failed required a higher FiO2 (0.56 vs. 0.47, p = 0.038), had higher respiratory rates (53.3 vs. 40.3 breaths/min, p = 0.012) and lower pH (7.26 vs. 7.34, p = 0.032) before NIV and higher FiO2 after NIV commenced (0.54 vs. 0.43, p = 0.009). Those with a respiratory diagnosis were more likely to be successful. Patients with oncologic disease, particularly if septic, were less likely to avoid intubation using NIV. Multivariable models showed that after adjustment for mode of NIV and underlying diagnosis, respiratory rate before NIV was an independent predictor of success [adjusted odds ratio (OR) 0.95 (0.91, 0.99), p = 0.01]. Eighty patients were extubated to NIV but 15 required re-intubation. Those re-intubated had a higher systolic blood pressure (104 vs. 77.9 mmHg, p = 0.001) and diastolic blood pressure (64.5 vs. 54.1 mmHg, p = 0.0037) after extubation. Multivariable models showed that systolic blood pressure 2 h after extubation was independently associated with outcome [adjusted OR 0.96 (0.93, 0.99), p = 0.007]. Parameters relating to respiratory and cardiovascular status can determine which patients will successfully avoid intubation or re-intubation when placed on NIV. Underlying disease and reason for admission should be considered when predicting the outcome of NIV. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full text from SpringerLink