Patient selection: critically-ill child
Factors associated with a failure of NIV on multiple regression analysis:
(1) Type 1 acute respiratory failure of Teague (ventilation-perfusion impairment, hypoxemia, parenchymal infiltrate on chest X-rays)
(2) higher PRISM score (mean 11.7 with SD 7.6 in failure group; mean 7.4 with SD 4.4 in successful group; use >= 11 in the implementation)
(3) lower decrease in the respiratory rate at 1 hour after initiating NIV (mean 4.9 with SD 11.9 in failure group; mean 12.2 with SD 12.9 in successful group; use < 12 in the implementation)
(4) lower decrease in the respiratory rate 6 hours (persistent tachypnea) after initiating NIV (mean 3.1 with SD 18.2 in failure group; mean 17.8 with SD 16.4 in successful group; use < 17 in the implementation)
where:
• Type 2 acute respiratory failure involves hypoventilation, hypercapnia without hypoxemia, absence of pulmonary infiltrate.
• A higher PRISM score indicates a sicker child.
• The decrease in respiratory rate is the difference between the respiratory rates before and after starting NIV. A child responding to NIV should have a respiratory rate closer to normal.
The more of the factors identified the more likely that the child will failure NIV.
