Retrospective Cohort Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Sep 7, 2018; 7(4): 46-51
Published online Sep 7, 2018. doi: 10.5492/wjccm.v7.i4.46
Clinical characteristics and outcomes associated with nasal intermittent mandatory ventilation in acute pediatric respiratory failure
Billy C Wang, Theodore Pei, Cheryl B Lin, Rong Guo, David Elashoff, James A Lin, Carol Pineda
Billy C Wang, Department of Pediatrics, Division of Critical Care Medicine, Loma Linda University Children’s Hospital, Loma Linda, CA 92354, United States
Theodore Pei, Cheryl B Lin, Carol Pineda, Department of Pediatrics, Division of Pediatric Critical Care, Floating Hospital for Children at Tufts, Boston, MA 02111, United States
Rong Guo, David Elashoff, Department of Medicine, Biostatistics Core, UCLA David Geffen School of Medicine, Los Angeles, CA 90024, United States
James A Lin, Department of Pediatrics, Mattel Children’s Hospital at UCLA, Los Angeles, CA 90095, United States
Author contributions: Wang BC, Pei T, Pineda C and Lin JA designed the study, collected data, and participated in writing and revision of the manuscript; Lin CB collected data and reviewed the manuscript; Guo R and Elashoff D provided statistical analysis and reviewed the manuscript
Supported by NIH National Center for Advancing Translational Science, No. UL1TR001881.
Institutional review board statement: This study was approved by the UCLA Institutional Review Board.
Conflict-of-interest statement: All authors have no conflicts of interest to report.
STROBE statement: The STROBE Statement have been adopted.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Billy C Wang, MD, Fellow, Department of Pediatrics, Division of Critical Care Medicine, Loma Linda University Children’s Hospital, 11234 Anderson Street Room CH5763, Loma Linda, CA 92354, United States. bcwang@llu.edu
Telephone: +1-909-5584250 Fax: +1-909-5580303
Received: June 2, 2018
Peer-review started: June 2, 2018
First decision: July 9, 2018
Revised: July 25, 2018
Accepted: August 4, 2018
Article in press: August 5, 2018
Published online: September 7, 2018
ARTICLE HIGHLIGHTS
Research background

Nasal intermittent mandatory ventilation (NIMV) is a mode of noninvasive ventilation (NIV) seldomly utilized outside of the neonatal intensive care unit (NICU). To our knowledge NIMV has not been studied in the pediatric intensive care unit (PICU) population.

Research motivation

Acute respiratory failure requiring advanced respiratory support accounts for a large proportion of PICU admissions. NIV is rapidly gaining acceptance as the first mode of oxygenation and ventilatory support for many of these patients. The potential use of NIMV adds to the arsenal of respiratory support strategies. Its success could obviate the need for mechanical ventilation in some patients.

Research objective

Our primary objectives were to review our experience with NIMV-both alone and in conjunction with other modes of NIV-and describe our patient outcome data and compare with existing literature. In particular our interests were intubation rate, PICU length of stay, hospital length of stay, duration of respiratory support, and complications.

Research methods

During our study period, we identified all patients who utilized NIMV with or without other modes of NIV at two academic institutions. We excluded patients in the NICU, those dependent on chronic continuous positive airway pressure (CPAP) or bilevel positive airway pressure or tracheostomy, and post-extubation NIV. Data included demographics, vitals, characteristics of respiratory support, diagnoses, complications, and outcome data. Patients who did not require escalation to mechanical ventilation (MV) were defined as NIMV responders; those who required escalation to MV were defined as NIMV non-responders. NIMV responders were compared to NIMV non-responders. Standard descriptive statistics are used. All statistical analyses were run by a certified biostatistician using SAS v9.4.

Research results

We identified 42 patients during our three-year study period. Median age of these patients was 4 mo. The majority of patients had a primary diagnosis of bronchiolitis. Six failed NIMV. Baseline demographics, vitals, diagnoses, and pediatric risk of mortality III scores were similar between NIMV responders and NIMV non-responders. However, NIMV non-responders were on this mode of ventilation for a significantly shorter period of time. Outcome data including hospital length of stay, PICU length of stay, and duration of respiratory support were similar between the two groups. No patients had aspiration pneumonia, pneumothorax, or skin breakdown associated with NIMV. There was a single mortality due to an uncorrectable and fatal lung pathology.

Research conclusions

NIMV was utilized in pediatric patients with acute respiratory failure and successfully supported the majority of our patients. Failure of NIMV was quickly identified in a median of 6.5 h. Patients who required intubation did not have a longer PICU length of stay, hospital length of stay, or total duration of respiratory support when compared to those successfully supported with NIMV.

Research perspectives

Based on our data, NIMV appears to be a promising mode of noninvasive respiratory support. Future goals include prospective, and randomized studies to describe and evaluate the efficacy of NIMV.