Noninvasive ventilation to facilitate extubation in a pediatric intensive care unit

Noninvasive ventilation has been used extensively to treat chronic respirat ory failure associated with neuromuscular and other restrictive thoracic di seases, and is also effective in the treatment of acute respiratory failure , allowing some patients to avoid intubation. Noninvasive positive pressure ventilation is a potentially effective way to transition selected patients off endotracheal mechanical ventilation. The authors present a retrospecti ve chart review of pediatric patients extubated with the use of noninvasive ventilation. Extubation with noninvasive positive pressure ventilation was attempted in 25 patients. The patients had a variety of diagnoses, includi ng neuromuscular diseases, cerebral palsy with chronic respiratory insuffic iency, asthma, and acute respiratory distress syndrome (ARDS), reflecting t he diversity of patients with respiratory failure seen in our pediatric int ensive care unit (ICU). Indications for noninvasive ventilation-assisted ex tubation were chronic respiratory insufficiency, clinical evidence the pati ent was failing extubation, or failure of a previous attempt to extubate. E xtubation was successfully facilitated in 20 of 25 patients. Of the five pa tients failing an initial attempt at noninvasive ventilation-assisted extub ation, two required tracheostomy, two were subsequently extubated with the aid of noninvasive ventilation, and one was subsequently extubated without the use of noninvasive ventilation. Risk factors for failure to successfull y extubate with the assistance of noninvasive positive pressure ventilation included the patient's inability to manage respiratory tract secretions, s evere upper airway obstruction, impaired mental status, and ineffective cou gh with mucus plugging of the large airways. All patients had mild to moder ate skin irritation due to the mask interface. No patient had any serious o r long-term adverse effect of noninvasive positive pressure ventilation. Al l patients left the hospital alive. Noninvasive positive pressure ventilati on can facilitate endotracheal extubation in pediatric patients with divers e diagnoses who have failed or who are at risk of failing extubation, inclu ding those with neuromuscular weakness.