UMEM Educational Pearls


Emergency physicians are often confronted with the child with acute respiratory failure.  Noninvasive ventilation (NIV) strategies such as continuous positive airway pressure (CPAP) and Bi-level positive airway pressure (BiPAP) can help support the child with reversible airway disease. Some children fail NIV and require endotracheal intubation and mechanical ventilation.
Certain clinical markers have been shown to predict failure of NIV in the ICU setting.  Early identification of failure can reduce the delay to definitive therapy and may further reduce morbidity and mortality.
Simply checking the level of FiO2 one hour after starting NIV can predict failure.  In one prospective cohort, an FiO2 > 80% after one hour reasonably predicted need for intubation in patients with a variety of underlying respiratory pathology.  In contrast, the responder group had mean oxygen requirement of 48% FiO2.
Najaf-Zadeh A, Leclerc F. Noninvasive positive pressure ventilation for acute respiratory failure in children: a concise review. Annals of Intensive Care 2001, 1:15.
Bernet et al. Predictive factors for the success of noninvasive mask ventilation in infants and children with acute respiratory failure. Pediatr Crit Care Med 2005, 6:6.