Non-Invasive Ventilation for Pediatric Acute Respiratory Distress Syndrome (PARDS): experience from the 2016/2017 PARDIE (PARDS Incidence and Epidemiology) prospective cohort study

作者：G. Emeriaud, M. Pons-Òdena, A. Bhalla, S. Shein, E. Killien, V. Modesto i Alapont, C. Rowan, F. Baudin, John C Lin, G. Grégoire, N. Napolitano, J. Mayordomo-Colunga, F. Díaz, P. Cruces, A. Medina, Lincoln Smith, R. Khemani · 发表于：Pediatric Critical Care Medicine · 年份：2023 · DOI：10.1097/PCC.0000000000003281 · 被引用次数：21 · 研究领域：Medicine

OBJECTIVES: The worldwide practice and impact of noninvasive ventilation (NIV) in pediatric acute respiratory distress syndrome (PARDS) is unknown. We sought to describe NIV use and associated clinical outcomes in PARDS. DESIGN: Planned ancillary study to the 2016/2017 prospective Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology study. SETTING: One hundred five international PICUs. PATIENTS: Patients with newly diagnosed PARDS admitted during 10 study weeks. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Children were categorized by their respiratory support at PARDS diagnosis into NIV or invasive mechanical ventilation (IMV) groups. Of 708 subjects with PARDS, 160 patients (23%) received NIV at PARDS diagnosis (NIV group). NIV failure rate (defined as tracheal intubation or death) was 84 of 160 patients (53%). Higher nonrespiratory pediatric logistic organ dysfunction (PELOD-2) score, Pao2/Fio2 was less than 100 at PARDS diagnosis, immunosuppression, and male sex were independently associated with NIV failure. NIV failure was 100% among patients with nonrespiratory PELOD-2 score greater than 2, Pao2/Fio2 less than 100, and immunosuppression all present. Among patients with Pao2/Fio2 greater than 100, children in the NIV group had shorter total duration of NIV and IMV, than the IMV at initial diagnosis group. We failed to identify associations between NIV use and PICU survival in a multivariable Cox regression analysis (hazard ratio 1.04 [95% CI, ...