Predictors of early synchronized non-invasive ventilation failure for infants Nesrin M Handoka  1 , Mona Azzam  2 , Ayman Gobarah  2 Affiliations Expand Affiliations 1 Pediatrics Department, Faculty of Medicine, Port-Said University, Port-Said, Egypt. 2 Pediatrics Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt. PMID: 31110534 PMCID: PMC6524188 DOI: 10.5114/aoms.2019.83040 Free PMC article Item in Clipboard

Nesrin M Handoka, Mona Azzam, Ayman Gobarah, Nesrin M Handoka, Mona Azzam, Ayman Gobarah

Abstract

Introduction: The current trend in management of preterm neonates with respiratory distress syndrome is to attempt noninvasive ventilation (NIV) to avoid endotracheal intubation. However, failure of noninvasive ventilation may lead to increased morbidity and mortality. There is a scarcity of studies establishing predictors for the usefulness of NIV in this age group. Our aim here was to determine the predictors of NIV in preterm infants with respiratory distress syndrome (RDS) treated with synchronized nasal intermittent positive pressure ventilation (SNIPPV) for initial respiratory support.

Material and methods: We conducted a follow-up study on 85 infants < 32 weeks of gestational age, and < 1500 g with RDS who received early SNIPPV. Perinatal history, physical characteristics, ventilatory settings, and arterial blood gas analysis results were collected. We recorded the failure rate and potential predictive factors of this failure.

Results: There were 12 (14.1%) patients who had SNIPPV failure. The SNIPPV failure group had multiple significantly different characteristics compared to the successful SNIPPV group including gestation age, birth weight, grading of disease, severity of respiratory distress, antenatal steroid use and various ventilatory settings. Further multivariate analysis revealed only 3 predictors in our patients: grade of RDS (OR = 4.48, p = 0.008), antenatal steroid use (OR = 1.09, p = 0.01) and mean airway pressure (OR = 1.98, p = 0.0001).

Conclusions: Failure of early NIV occurred in a small subset of our patients. Predictors of noninvasive ventilation failure may be a useful guide for decisions regarding intubation.

Keywords: predictors; preterm infants; respiratory distress syndrome; synchronized nasal intermittent positive pressure ventilation failure.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of patient assessment for eligibility, exclusion and follow-up

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