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Abstract
The application of Non-Invasive Respiratory Support (NIRS) has been increasingly used outside the pediatric intensive care units (PICUs). Early identification of disease progression or poor response to therapy is crucial for timely referral.
Objective: To describe the use of NIRS in general pediatric wards and to evaluate the risk factors associated with therapy failure and PICU referral.
Patients and Method: Retrospective, observational, single-center study in children under 24 months with acute lower respiratory tract infection (LRTI) who received NIRS in general wards during the winter seasons of 2021-2022. NIRS included high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), or bilevel positive airway pressure (BiPAP). Each event was individually characterized, documenting the type of support and its clinical response (success or failure). Failure was defined as the need for PICU admission. Demographic factors, clinical characteristics, and types of support used were compared between these groups using bivariate analysis and multivariate logistic regression.
Results: Out of a total of 415 patients, 14.2% experienced therapy failure. The main predictors of failure were age (adjusted OR = 0.87; 95% CI: 0.81-0.94), prematurity (adjusted OR = 2.52; 95% CI: 1.07-5.96), the presence of congenital heart disease (adjusted OR = 5.92; 95% CI: 2.13- 16.42), and a higher heart rate (adjusted OR = 1.25; 95% CI: 1.06-1.48). Clinical outcomes did not vary according to the type of NIRS used. Regarding the type of NIRS received, HFNC was used in 68.6% of the events, followed by CPAP (25.3%) and BiPAP (6.1%).
Conclusions: The use of NIRS in general pediatric wards prevented PICU referral in 85.8% of cases. The identified risk factors for re- ferral included younger age, prematurity, the presence of congenital heart disease, and a higher initial heart rate. HFNC emerged as the most commonly used respiratory support technique, followed by CPAP and BiPAP, which were primarily used as rescue strategies.
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