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Combined noninvasive ventilation and mechanical in‐exsufflator in the treatment of pediatric acute neuromuscular respiratory failure
Author(s) -
Chen TaiHeng,
Hsu JongHau,
Wu JiunnRen,
Dai ZenKong,
Chen IChen,
Liang WenChen,
Yang SanNan,
Jong YuhJyh
Publication year - 2014
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.22827
Subject(s) - medicine , anesthesia , mechanical ventilation , intubation , respiratory failure , tracheal intubation , neuromuscular disease , pneumonia , respiratory acidosis , acidosis , disease
Summary Objectives The present study aims to evaluate the efficacy and complications of combined noninvasive ventilation (NIV) and assisted coughing by mechanical in‐exsufflator (MIE) for acute respiratory failure (ARF) in children with neuromuscular disease (NMD). Methods A prospective study was conducted in the pediatric intensive care unit. Children with NMD and ARF treated by combined NIV and MIE were included. Treatment success was defined as freedom from tracheal intubation during the hospital stay. Physiologic indices including PaO 2 , PaCO 2 , pH, and PaO 2 /FiO 2 were recorded before and 12, 24 hr after the use of NIV/MIE. Results Combined NIV/MIE was used in 15 NMD children (mean: 8.1 years, range: 3 months to 18 years) with 16 cases of ARF. There was no mortality in this cohort. Treatment success was achieved in 12 cases (75%), including six cases (38%) demanding “Do Not Intubate.” ARF was due to pneumonia, with a mean baseline PaCO 2 of 73.2 ± 19.0 mmHg. In the success group, hypercarbia and acidosis improved after use of NIV/MIE for 24 hr (PaCO 2 : 71.7 ± 18.6 mmHg vs. 55.8 ± 11.6 mmHg, P < 0.01; pH: 7.29 ± 0.07 vs. 7.38 ± 0.05, P < 0.01). All patients tolerated NIV/MIE well despite transient skin pressure sores in five cases. Conclusions Combined NIV/MIE is a safe and effective approach to rapidly improve physiologic indices and decrease the need for intubation in NMD children with ARF. NIV/MIE provides a good alternative for those refusing intubation. Pediatr Pulmonol. 2014; 49:589–596. © 2013 Wiley Periodicals, Inc.