Abstract

LULE MORALES, MARÍA SILVIA et al. EFICIENCIA DE LA VENTILACIÓN MECÁNICA NO INVASIVA EN PACIENTES PEDIÁTRICOS CON INSUFICIENCIA RESPIRATORIA AGUDA. Rev. Inst. Nal. Enf. Resp. Mex. [online]. 2004, vol.17, n.3, pp.181-191. ISSN 0187-7585.

Background: In last years non-invasive positive pressure ventilation (NIPPV) has become a medical reality in the management of respiratory failure in adult and pediatric patients. This method reduces dead space, improves alveolar ventilation, biventricular heart function, and reduces hospital length of stay (LOS), nosocomial infections and costs. Knowing its advantages, it is very important to use it very early in the management of respiratory insufficiency, be it pulmonary or extrapulmonary, in the emergency room, intensive care or intermediate care facilities. It is also important to have trained personal, a conscious and cooperative pediatric patient and family support. Methods: Retrospective-prospective longitudinal, clinical experimental assay. Two groups were formed: (1) 14 patients with NIPPV and (2) 12 with AMVc; both with diagnosed ARF at our Intensive Respiratory Care Unit at the National Institute of Respiratory Diseases in Mexico City between July 1988 until November 2002. Results: In the group with NIPPV we found significant statistical differences in: adjusted respiratory and cardiac frequencies; PaCO₂ , PaO₂ /FiO₂ ; SpO₂ ; pH with values of p (0.002, 0.002, 0.001, 0.004, 0.001, and 0.006). In the other group (AMVc) statistical significance was found in respiratory frequency, PaCO₂ ,SpO₂ and pH with values of p (0.002, 0.009, 0.005, 0.003). RR wad calculated on 0.143. IC wad of 95%. NIPPV reduced the possibility of intubating a patient by 85%. Conclusions: NIPPV was successful in terms of avoiding intubation of our pediatric patients with ARF of hypercapnic type in 85% of our cases. It also reduced LOS and other possible complications such as nosocomial infections and biventricular function. Severe complications are less frequent with NIPPV and clinical and physiological variables improved in the two hours after initiating NIPPV.

Keywords : Acute respiratory failure; non invasive positive pressure ventilation; intensive respiratory care unit.