Mayorodomo-Colunga et al identified factors associated with a failure of noninvasive ventilation (NIV) for critically-ill children. These findings can help to identify patients who may benefit from more aggressive management and/or invasive ventilation. The authors are from University of Oviedo in Spain.


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)



• 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.


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