Noninvasive ventilation to facilitate extubation in a pediatric intensive care unit

Title

Noninvasive ventilation to facilitate extubation in a pediatric intensive care unit

Creator

Pope J F; Birnkrant D J

Publisher

Journal of Intensive Care Medicine

Date

2000
2000-03

Description

Noninvasive ventilation has been used extensively to treat chronic respiratory failure associated with neuromuscular and other restrictive thoracic diseases, and is also effective in the treatment of acute respiratory failure, allowing some patients to avoid intubation. Noninvasive positive pressure ventilation is a potentially effective way to transition selected patients off endotracheal mechanical ventilation. The authors present a retrospective chart review of pediatric patients extubated with the use of noninvasive ventilation. Extubation with noninvasive positive pressure ventilation was attempted in 25 patients. The patients had a variety of diagnoses, including neuromuscular diseases, cerebral palsy with chronic respiratory insufficiency, asthma, and acute respiratory distress syndrome (ARDS), reflecting the diversity of patients with respiratory failure seen in our pediatric intensive care unit (ICU). Indications for noninvasive ventilation-assisted extubation were chronic respiratory insufficiency, clinical evidence the patient was failing extubation, or failure of a previous attempt to extubate. Extubation was successfully facilitated in 20 of 25 patients. Of the five patients failing an initial attempt at noninvasive ventilation-assisted extubation, two required tracheostomy, two were subsequently extubated with the aid of noninvasive ventilation, and one was subsequently extubated without the use of noninvasive ventilation. Risk factors for failure to successfully extubate with the assistance of noninvasive positive pressure ventilation included the patient's inability to manage respiratory tract secretions, severe upper airway obstruction, impaired mental status, and ineffective cough with mucus plugging of the large airways. All patients had mild to moderate skin irritation due to the mask interface. No patient had any serious or long-term adverse effect of noninvasive positive pressure ventilation. All patients left the hospital alive. Noninvasive positive pressure ventilation can facilitate endotracheal extubation in pediatric patients with diverse diagnoses who have failed or who are at risk of failing extubation, including those with neuromuscular weakness.

Subject

children; face mask; General & Internal Medicine; insufficiency; intermittent; management; mechanical ventilation; nasal ventilation; positive-pressure ventilation; respiratory-failure; support

Format

Journal Article

Search for Full-text

Users with a NEOMED Library login can search for full-text journal articles at the following url: https://libraryguides.neomed.edu/home

Rights

Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).

Pages

99-103

Issue

2

Volume

15

Citation

Pope J F; Birnkrant D J, “Noninvasive ventilation to facilitate extubation in a pediatric intensive care unit,” NEOMED Bibliography Database, accessed January 23, 2021, https://neomed.omeka.net/items/show/6789.

Social Bookmarking