Outcomes of Noninvasive Positive Pressure Ventilation via RAM Cannula in Pediatric Intensive Care: A Preliminary Report.

BACKGROUND

Experience in the use of noninvasive positive pressure ventilation (NIPPV) via RAM cannula in the Pediatric Intensive Care Unit (PICU) is limited.

OBJECTIVE

The objective of this study is to describe the characteristics, outcomes, and complications of patients receiving NIPPV via RAM cannula in our PICU.

METHODS

A 12-month (Jan-Dec 2024) retrospective cohort study included 60 children (1 month-18 years) who received NIPPV via RAM cannula. Patients undergoing elective intubation, with do-not-resuscitate orders or with incomplete records, were excluded. Initial NIPPV settings were PEEP 5-12 cm H2O, inspiratory pressure 15-28 cm H2O, and FiO2 titrated to maintain SpO2 ≥ 92%. NIPPV failure was defined as escalation to invasive ventilation. Data were analyzed using STATA.

RESULT: A total of 60 were included with a median age of 15.6 months (IQR 7-41.5). Admitting diagnosis were respiratory illnesses (36; 60%), cardiac disease (9; 15%), and sepsis with MODS (6; 10%). NIPPV indications include respiratory distress in 42 (70%) patients and postextubation support in 18 (30%) patients. Success was achieved in 44 patients (73.3%). Failure was associated with comorbidities (adjusted OR 0.024, p = 0.010), higher PRISM III scores (adjusted OR 0.745, p = 0.008), higher PEEP (9.8 vs. 8.4 cm H2O, p = 0.018), and FiO2 (90.6% vs. 60.9%, p < 0.001). A higher SF ratio was associated with success (189 vs. 136, p < 0.001). Failures had more pneumothorax (31% vs. 2.3%, p = 0.001), longer PICU stay. (18.3 vs. 8.9 days, p < 0.001), and 50% mortality rate, with no deaths among successful cases.

CONCLUSION

NIPPV is an effective respiratory support modality in the PICU. Predictors of success are lower illness severity, no comorbidities, and better oxygenation.