Failure of High-Flow Nasal Cannula and Non-invasive Ventilation Can Be Associated with Increased Risk of Mortality and Morbidity in Critically Ill Children
Abstract Background: This retrospective study aimed to describe the efficacy, complications, and outcome of non-invasive mechanical ventilation (NIV) in critically ill children. Non-invasive mechanical ventilation (NIV) has achieved a significant breakthrough success in treating acute respiratory failure. NIV failure drastically increases the risk of mortality and morbidity. Many factors have been associated with the success of NIV. Methods. We performed a multicenter retrospective study using the demographic, prognostic, and laboratory findings of children (<18 years old) who were admitted in two pediatric intensive care units (PICUs). We compared clinical and laboratory variables in both successful and failed NIV groups. Results. Between January 2014 and April 2019, 1101 children were admitted to two PICU wards, of which, 403 were eligible for this study. In total, 138 (34.2%) patients received high-flow nasal cannula (HFNC), 138 (34.2%) patients received NIV-pressure control and 127 (31.6%) received NIV-pressure support (PSV). Patient mortality was 3.2% (13 patients) and the success rate of our study was 83.4%. Majority of our patients were provided NIV on admission (62.8%). Patients with successful NIV required fewer inotropic drugs, had shorter PICU stay duration, and a lower mortality rate during the follow up. The failure group presented a greater frequency of NIV-PSV and NIV-PCV use, along with higher NIV-associated complications. Logistic regression analysis revealed that NIV and HFNC failure increased PICU mortality by 19 times. Conclusions. HFNC and NIV are support modalities for respiratory distress in the PICU and were associated with a significant decrease in the PICU intubation rate.