Non-invasive ventilation practices in children across Europe

Abstract

ObjectivesTo describe the diversity in practice in non-invasive ventilation (NIV) in European pediatric intensive care units (PICUs). Working hypothesisNo information about the use of NIV in Pediatrics across Europe is currently available, and there might be a wide variability regarding the approach. Study designCross-sectional electronic survey. MethodologyThe survey was distributed to the ESPNIC mailing list and to researchers in different European centers. ResultsOne hundred one units from 23 countries participated. All respondent units used NIV. Almost all PICUs considered NIV as initial respiratory support (99.1%), after extubation (95.5% prophylactically, 99.1% therapeutically), and 77.5% as part of palliative care. Overall NIV use outside the PICUs was 15.5% on the ward, 20% in the emergency department, and 36.4% during transport. Regarding respiratory failure cause, NIV was delivered in pneumonia (97.3%), bronchiolitis (94.6%), bronchospasm (75.2%), acute pulmonary edema (84.1%), upper airway obstruction (76.1%), and in acute respiratory distress syndrome (91% if mild, 53.1% if moderate, and 5.3% if severe). NIV use in asthma was less frequent in Northern European units in comparison to Central and Southern European PICUs (P=0.007). Only 47.7% of the participants had a written protocol about NIV use. Bilevel NIV was applied mostly through an oronasal mask (44.4%), and continuous positive airway pressure through nasal cannulae (39.8%). If bilevel NIV was required, 62.3% reported choosing pressure support (vs assisted pressure-controlled ventilation) in infants; and 74.5% in older children. ConclusionsThe present study shows that NIV is a widespread technique in European PICUs. Practice across Europe is variable.