Feasibility of non-invasive pressure support ventilation in infants with respiratory failure after extubation: a pilot study

Objective: To evaluate the feasibility and effects of non-invasive pressure support ventilation (NIV) on the breathing pattern in infants developing respiratory failure after extubation. Design: Prospective pilot clinical study; each patient served as their own control. Setting: A nine-bed paediatric intensive care unit of a tertiary university hospital. Patients: Six patients (median age 5months, range 0.5-7months; median weight 4.2kg, range 3.8-5.1kg) who developed respiratory failure after extubation. Interventions: After a period of spontaneous breathing (SB), children who developed respiratory failure were treated with NIV. Measurements and results: Measurements included clinical dyspnoea score (DS), blood gases and oesophageal pressure recordings, which were analysed for respiratory rate (RR), oesophageal inspiratory pressure swing (dPes) and oesophageal pressure-time product (PTPes). All data were collected during both periods (SB and NIV). When comparing NIV with SB, DS was reduced by 44% (P<0.001), RR by 32% (P<0.001), dPes by 45% (P<0.01) and PTPes by 57% (P<0.001). A non-significant trend for decrease in PaCO2 was observed. Conclusion: In these infants, non-invasive pressure support ventilation with turbine flow generator induced a reduction of breathing frequency, dPes and PTPes, indicating reduced load of the inspiratory muscles. NIV can be used with some benefits in infants with respiratory failure after extubatio