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Intensive Care Medicine
Published in: Intensive Care Medicine 9/2011

01-09-2011 | Pediatric Original

The number of failing organs predicts non-invasive ventilation failure in children with ALI/ARDS

Authors: Marco Piastra, Daniele De Luca, Laura Marzano, Eleonora Stival, Orazio Genovese, Domenico Pietrini, Giorgio Conti

Published in: Intensive Care Medicine | Issue 9/2011

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Abstract

Purpose

Non-invasive positive pressure ventilation (NIV) is being increasingly used in paediatric critical care, although its use in acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) is still debated. No definite data are available for the prediction of NIV outcome in such selected populations. We aimed to identify which factors might affect NIV failure in paediatric ALI/ARDS patients.

Methods

A retrospective cohort study using comprehensive predictivity analysis was performed. All children admitted to our paediatric intensive care unit over a 4-year period for ALI/ARDS were reviewed. Basic, clinical, physiological parameters and their change after 1 h of NIV were considered and subjected to univariate analysis. Candidate prognostic variables were then subjected to multicollinearity scrutiny and logistic regression. Finally, variables significant in the logistic regression were subjected to predictivity analysis.

Results

The number of organ failures at admission (NOF) is a strong predictor of NIV failure (odds ratio 5.26; p = 0.004). Having only one organ failure provides a probability of NIV success of 85.7% (sensitivity 87%; specificity 49%). One NIV failure will be predicted and avoided for every four cases in which the presence of other organ failures is incorporated into the clinical decision.

Conclusions

NOF significantly predicts the NIV failure. Children with no organ failures other than ALI/ARDS may safely be treated with NIV.
Appendix
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Metadata
Title
The number of failing organs predicts non-invasive ventilation failure in children with ALI/ARDS
Authors
Marco Piastra
Daniele De Luca
Laura Marzano
Eleonora Stival
Orazio Genovese
Domenico Pietrini
Giorgio Conti
Publication date
01-09-2011
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 9/2011
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-011-2308-z

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