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05.02.2020 | Original Article | Ausgabe 4/2020

Pediatric Cardiology 4/2020

Use of Noninvasive Ventilation in Respiratory Failure After Extubation During Postoperative Care in Pediatrics

Zeitschrift:
Pediatric Cardiology > Ausgabe 4/2020
Autoren:
Denise S. Rolim, Filomena R. B. Galas, Lucilia S. Faria, Erica F. Amorim, Marisa M. Regenga, Eduardo J. Troster
Wichtige Hinweise
The work was performed at Pediatric Intensive Care Unit from Hospital Sírio Libanês (HSL), São Paulo, SP, Brazil; Hospital do Coração (HCor), São Paulo, SP, Brazil and Heart Institute (InCor), Hospital das Clinicas of Medical College at Universidade de São Paulo, São Paulo, SP, Brazil.

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Abstract

The purpose of this study was to determine the rate of failure of noninvasive ventilation (NIV) after cardiac surgery in pediatric patients with respiratory failure after extubation and to identify predictive success factors. This was a prospective cohort study of pediatric patients diagnosed with congenital heart disease who underwent heart surgery and used NIV. Data were collected from 170 patients with a median age of 2 months. No patient presented cardiorespiratory arrest nor any other complication during the use of NIV. The success rate for the use of NIV was 61.8%. Subjects were divided for analysis into successful and failed NIV groups. Statistical analysis used Chi-square, Mann–Whitney, and Student’s t tests, which were performed after univariate and multivariate logistic regression for p < 0.05. In the multivariate analysis, only the minimal pressure gradient (OR 1.45 with p = 0.007), maximum oxygen saturation (OR 0.88 with p = 0.011), and maximum fraction of inspired oxygen (FiO2) (OR 1.16 with p < 0.001) influenced NIV failure. The following variables did not present a statistical difference: extracorporeal circulation time (p = 0.669), pulmonary hypertension (p = 0.254), genetic syndrome (p = 0.342), RACHS-1 score (p = 0.097), age (p = 0.098), invasive mechanical ventilation duration (p = 0.186), and NIV duration (p = 0.804). In conclusion, NIV can be successfully used in children who, after cardiac surgery, develop respiratory failure in the 48 h following extubation. Although the use of higher pressure gradients and higher FiO2 are associated with a greater failure rate for NIV use, it was found to be generally safe.

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