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Intensive Care Med. 2009 Aug;35(8):1420-7. doi: 10.1007/s00134-009-1558-5. Epub 2009 Jun 23.

Noninvasive pressure-support ventilation in immunocompromised children with ARDS: a feasibility study.

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Pediatric Intensive Care Unit, Department of Anaesthesiology and Intensive Care, Catholic University of the Sacred Heart, University Hospital A.Gemelli, L.go A. Gemelli 8, 00168 Rome, Italy.



To verify the feasibility of non-invasive ventilation (NIV) in immunocompromised children affected by ARDS.


University Hospital PICU.


Twenty-three consecutive immunocompromised children treated with NIV for ARDS.


All consecutive patients received NIV through a face-mask or a helmet.


No differences were found regarding admission data and severity scores between NIV responders and non-responders. Early and sustained improvement in PaO2/FiO2 ratio were observed in 82 and 74% of cases, respectively. 13 out of 23 patients (54.5%) avoided intubation and were discharged from the PICU; ten patients required intubation: two of them survived and eight patients died (two refractory hypoxemia, three septic shock, three multi-organ failure). PICU and intra-hospital mortality was significantly higher for NIV-nonresponders (P < 0.001). PICU stay was significantly shorter for NIV responders (P = 0.03). NIV responders had significantly lower heart and respiratory rate at the end of treatment (P < 0.001 and P = 0.048, respectively).


NIV administration is feasible and well tolerated in immunocompromised children with ARDS. A short NIV trial can be used to verify the usefulness of the technique. A randomized controlled trial is needed to confirm the efficacy of NIV in immunocompromised children requiring ventilatory support for ARDS.

[Indexed for MEDLINE]

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