TY - JOUR
T1 - Risk Factors for Noninvasive Ventilation Failure in Children Post-Hematopoietic Cell Transplant
AU - Hematopoietic Cell Transplant subgroup of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network
AU - Rowan, Courtney M.
AU - Fitzgerald, Julie C.
AU - Agulnik, Asya
AU - Zinter, Matt S.
AU - Sharron, Matthew P.
AU - Slaven, James E.
AU - Kreml, Erin M.
AU - Bajwa, Rajinder P.S.
AU - Mahadeo, Kris M.
AU - Moffet, Jerelyn
AU - Tarquinio, Keiko M.
AU - Steiner, Marie E.
N1 - Publisher Copyright:
© Copyright © 2021 Rowan, Fitzgerald, Agulnik, Zinter, Sharron, Slaven, Kreml, Bajwa, Mahadeo, Moffet, Tarquinio and Steiner.
PY - 2021/5/27
Y1 - 2021/5/27
N2 - Rationale: Little is known on the use of noninvasive ventilation (NIPPV) in pediatric hematopoietic cell transplant (HCT) patients.Objective: We sought to describe the landscape of NIPPV use and to identify risk factors for failure to inform future investigation or quality improvement.Methods: This is a multicenter, retrospective observational cohort of 153 consecutive children post-HCT requiring NIPPV from 2010-2016.Results: 97 (63%) failed NIPPV. Factors associated with failure on univariate analysis included: longer oxygen use prior to NIPPV (p=0.04), vasoactive agent use (p<0.001), and higher respiratory rate at multiple hours of NIPPV use (1hr p=0.02, 2hr p=0.04, 4hr p=0.008, 8hr p=0.002). Using respiratory rate at 4 hours a multivariable model was constructed. This model demonstrated high ability to discriminate NIPPV failure (AUC=0.794) with the following results: respiratory rate >40 at 4 hours [aOR=6.3 9(95% CI: 2.4, 16.4), p<0.001] and vasoactive use [aOR=4.9 (95% CI: 1.9, 13.1), p=0.001]. Of note, 11 patients had a cardiac arrest during intubation (11%) and 3 others arrested prior to intubation. These 14 patients were closer to HCT [14 days (IQR:4, 73) vs 54 (IQR:21,117), p<0.01] and there was a trend toward beginning NIPPV outside of the PICU and arrest during/prior to intubation (p=0.056).Conclusions: In this cohort respiratory rate at 4 hours and vasoactive use are independent risk factors of NIPPV failure. An objective model to predict which children may benefit from a trial of NIPPV, may also inform the timing of both NIPPV initiation and uncomplicated intubation.
AB - Rationale: Little is known on the use of noninvasive ventilation (NIPPV) in pediatric hematopoietic cell transplant (HCT) patients.Objective: We sought to describe the landscape of NIPPV use and to identify risk factors for failure to inform future investigation or quality improvement.Methods: This is a multicenter, retrospective observational cohort of 153 consecutive children post-HCT requiring NIPPV from 2010-2016.Results: 97 (63%) failed NIPPV. Factors associated with failure on univariate analysis included: longer oxygen use prior to NIPPV (p=0.04), vasoactive agent use (p<0.001), and higher respiratory rate at multiple hours of NIPPV use (1hr p=0.02, 2hr p=0.04, 4hr p=0.008, 8hr p=0.002). Using respiratory rate at 4 hours a multivariable model was constructed. This model demonstrated high ability to discriminate NIPPV failure (AUC=0.794) with the following results: respiratory rate >40 at 4 hours [aOR=6.3 9(95% CI: 2.4, 16.4), p<0.001] and vasoactive use [aOR=4.9 (95% CI: 1.9, 13.1), p=0.001]. Of note, 11 patients had a cardiac arrest during intubation (11%) and 3 others arrested prior to intubation. These 14 patients were closer to HCT [14 days (IQR:4, 73) vs 54 (IQR:21,117), p<0.01] and there was a trend toward beginning NIPPV outside of the PICU and arrest during/prior to intubation (p=0.056).Conclusions: In this cohort respiratory rate at 4 hours and vasoactive use are independent risk factors of NIPPV failure. An objective model to predict which children may benefit from a trial of NIPPV, may also inform the timing of both NIPPV initiation and uncomplicated intubation.
KW - cardiopulmonary resuscitation
KW - hematopoietic (stem) cell transplantation (HCT)
KW - intubation
KW - noninvasive (positive pressure) ventilation
KW - respiratory insufficiency
UR - http://www.scopus.com/inward/record.url?scp=85107554395&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85107554395&partnerID=8YFLogxK
U2 - 10.3389/fonc.2021.653607
DO - 10.3389/fonc.2021.653607
M3 - Article
C2 - 34123807
AN - SCOPUS:85107554395
SN - 2234-943X
VL - 11
JO - Frontiers in Oncology
JF - Frontiers in Oncology
M1 - 653607
ER -
