NON-INVASIVE APPLICATION OF BI-LEVEL POSITIVE AIRWAY PRESSURE TO PREVENT ENDOTRACHEAL INTUBATION IN ACUTE RESPIRATORY FAILURE:

Limited data exist regarding feeding pediatric patients managed on non-invasive respiratory support (NRS) modes that augment oxygenation and ventilation in the setting of acute respiratory failure. We conducted a retrospective cohort study to explore the safety of feeding patients managed on NRS with acute respiratory failure secondary to bronchiolitis. Children up to two years old with critical bronchiolitis managed on continuous positive airway pressure, bilevel positive airway pressure, or RAM cannula were included. Of the 178 eligible patients, 64 were reportedly nil per os (NPO), while 114 received enteral nutrition (EN). Overall equivalent in severity of illness, younger patients populated the EN group, while the NPO group experienced a higher incidence of intubation. Duration of stay in the pediatric intensive care unit and non-invasive respiratory support were shorter in the NPO group, though intubation eliminated the former difference. Within the EN group, ninety percent had feeds initiated within 48 h and 94% reached full feeds within 7 days of NRS initiation, with an 8% complication and <1% aspiration rate. Reported complications did not result in escalation of respiratory support. Notably, a significant improvement in heart rate and respiratory rate was noted after feeds initiation. Taken together, our study supports the practice of early enteral nutrition in patients with critical bronchiolitis requiring NRS.

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P0437 / #2122: OUTCOMES OF NON-INVASIVE BI-LEVEL POSITIVE AIRWAY PRESSURE VENTILATION AS INITIAL MANAGEMENT OF ACUTE RESPIRATORY FAILURE IN PEDIATRIC CRITICAL CARE

Pediatric Critical Care Medicine ◽

10.1097/01.pcc.0000740088.62357.9b ◽

2021 ◽

Vol 22 (Supplement 1 3S) ◽

pp. 224-224

Author(s):

L. Bermudez ◽

L. Sáez ◽

M. Gutiérrez ◽

M. Brezmes-Raposo ◽

C. Fernandez ◽

...

Keyword(s):

Critical Care ◽

Respiratory Failure ◽

Acute Respiratory Failure ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Pediatric Critical Care ◽

Initial Management ◽

Non Invasive ◽

Positive Airway Pressure Ventilation

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Evaluation of the ROX index in SARS-CoV-2 Acute Respiratory failure treated with both High-Flow Nasal Oxygen (HFNO) and Continuous Positive Airway Pressure (CPAP)

10.1101/2021.03.23.21254203 ◽

2021 ◽

Author(s):

Hakim Ghani ◽

Michael Shaw ◽

Phyoe Pyae ◽

Rigers Cama ◽

Meghna Prabhakar ◽

...

Keyword(s):

Respiratory Failure ◽

Continuous Positive Airway Pressure ◽

Acute Respiratory Failure ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Invasive Mechanical Ventilation ◽

High Flow ◽

Time To Failure ◽

Cut Points ◽

Non Invasive

Background: Non-invasive respiratory support including high-flow nasal oxygen (HFNO), and continuous positive airway pressure (CPAP) have been used to provide therapy in selected SARS-CoV-2 patients with acute respiratory failure (ARF). The value of the ROX index, a validated benchmark for outcomes in HFNO is unknown in CPAP. Objective: Can the ROX, a validated benchmark in HFNO be used for measuring treatment outcomes of CPAP in SARS-COV-2 ARF? Study Design and Methods: A non-randomised prospective protocol driven observational non-intensive care unit study in 130 SARS-COV-2 patients with ARF treated with non-invasive therapy from March 2020 to January 2021. The primary end point was failure of therapy (death or escalation). Secondary outcomes included time to failure including invasive mechanical ventilation (IMV) or death, the effect of escalation to CPAP from HFNO and the utility of ROX in ARF. Results: HFNO was better than CPAP in treating SARS-COV-2 ARF: 17/35 (48.5%) with successful HFNO therapy versus 24/95 (25.2%) with CPAP. The ROX index was more sensitive to outcomes with CPAP compared to HFNO and distinguished treatment failure early at 1, 4, 6, 12, and 24 hours with the highest sensitivity at 24 hours (ROX-24h). The AUC for the ROX-24h was 0.77 for HFNO (P<0.0001), and 0.84 for CPAP (P<0.0001). The ROX-24h cut-points predicted failure with HFNO when < 3.9 (PPV 71%, NPV 75%) and CPAP < 4.3 (PPV 75%, NPV 91%). For success, ROX-24h cut-points of 7.6 for HFNO (PPV 85%, NPV 48%) and 6.1 for CPAP (PPV 88%, NPV 62%) were observed. Escalation from HFNO to CPAP was mostly not successful. Conclusion: ARF in SARS-COV-2 can be successfully managed by non-invasive support. The ROX index, validated for HFNO, provides a timely, low resource measure for both HFNO and CPAP avoiding delayed intubation. Trial registration: Study approved by NHS HRAREC (20/HRA/2344;ethics 283888)

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