ABSTRACT
OBJECTIVE: Noninvasive continuous positive airway pressure (CPAP) is widely used in pediatric patients with acute respiratory failure. However, the lack of specific interfaces and appropriate ventilators and poor tolerance of the technique by these patients can lead to failure of the application. The aim of this study was to analyze the efficacy of a CPAP system using a modified Mapleson breathing circuit during acute respiratory failure in pediatric patients. MATERIAL AND METHODS: We performed a prospective observational study in children with acute respiratory failure in whom noninvasive ventilation was indicated. CPAP was applied through a Mapleson D circuit fitted with a manometer and a nasopharyngeal tube as the interface. Heart rate, respiratory rate, inspired oxygen fraction (FiO2), PaO2, PaCO2, and pulse oximetry were measured before treatment and after 2 hours of treatment. RESULTS: Sixteen patients with a mean age of 3.8 years were studied for a period of 18 months. We observed a mean (SD) change in PaCO2 from 66.8 (18.08) mm Hg to 46.48 (5.9) mm Hg after CPAP (P=.16) and a mean change in the PaO2/FiO2 ratio from 201 (111) to 262 (115) after CPAP (P=.30). The mean heart rate fell from 156 (22) beats/min to 127 (18) beats/min (P=.05) and the mean respiratory rate from 53 (15) breaths/min to 33 (13) breaths/min (P<.05). No severe complications were recorded and tolerance was satisfactory. The technique was considered a success in 12 patients (75%). CONCLUSIONS: CPAP without a ventilator, through a Mapleson D circuit, can be used with a high success rate to provide noninvasive ventilation for pediatric patients with acute respiratory failure.
Subject(s)
Continuous Positive Airway Pressure/methods , Respiratory Insufficiency/therapy , Acute Disease , Carbon Dioxide/blood , Child , Child, Preschool , Continuous Positive Airway Pressure/instrumentation , Equipment Design , Female , Heart Rate , Humans , Hypercapnia/etiology , Hypercapnia/prevention & control , Hypercapnia/therapy , Hypoxia/etiology , Hypoxia/prevention & control , Hypoxia/therapy , Infant , Intensive Care Units, Pediatric , Intubation , Male , Nasal Cavity , Oxygen/blood , Partial Pressure , Patient Acceptance of Health Care , Prospective Studies , Respiratory Insufficiency/blood , Respiratory Insufficiency/complicationsABSTRACT
OBJETIVO: La CPAP en ventilación no invasiva es utilizadaampliamente en el paciente pediátrico con insuficienciarespiratoria aguda. Sin embargo la escasez deinterfases específicas, respiradores adecuados y la escasatolerancia de la técnica en estos pacientes pueden hacerfracasar su aplicación. El objetivo de este estudio fueanalizar la eficacia de un sistema de CPAP formado porun circuito respiratorio de Mapleson modificado, durantela IRA en pediatría.MATERIAL Y MÉTODOS: Estudio prospectivo observacionalrealizado en niños con insuficiencia respiratoriaaguda con indicación de ventilación no invasiva. LaCPAP se aplicó mediante un circuito respiratorio MaplesonD provisto de un manómetro y un tubo nasofaríngeocomo interfase. Se recogieron previo al tratamiento y 2horas después, frecuencia cardiaca, frecuencia respiratoria,fracción inspirada de oxígeno, presión arterial deoxígeno, de dióxido de carbono y pulsioximetría.RESULTADOS: Se incluyeron 16 pacientes de edadmedia 3,8 años durante un periodo de 18 meses. Observamosuna disminución PaCO2 desde 66,8±18,08 mmHga 46,48±5,9 mmHg tras CPAP (p=0,16) y un aumento enla relación PaO2/FiO2 de 201±111 a 262±115 mm Hg trasCPAP (p=0,30). La FC descendió de 156±22 a 127±18l/min (p=0,05) y la FR de 53±15 a 33±13 resp/min(p<0,05). No se registraron complicaciones graves y latolerancia fue adecuada. La técnica se consideró exitosaen 12 pacientes (75%).CONCLUSIONES: La aplicación de CPAP sin respiradormediante circuito Mapleson D puede ser utilizado comoventilación no invasiva en pacientes pediátricos con insuficienciarespiratoria aguda con elevada tasa de éxito (AU)
OBJETIVE: Noninvasive continuous positive airwaypressure (CPAP) is widely used in pediatric patients withacute respiratory failure. However, the lack of specificinterfaces and appropriate ventilators and poor tolerance ofthe technique by these patients can lead to failure of theapplication. The aim of this study was to analyze the efficacyof a CPAP system using a modified Mapleson breathingcircuit during acute respiratory failure in pediatric patients.MATERIAL AND METHODS: We performed a prospectiveobservational study in children with acute respiratoryfailure in whom noninvasive ventilation was indicated.CPAP was applied through a Mapleson D circuit fittedwith a manometer and a nasopharyngeal tube as theinterface. Heart rate, respiratory rate, inspired oxygenfraction (FiO2), PaO2, PaCO2, and pulse oximetry weremeasured before treatment and after 2 hours of treatment.RESULTS: Sixteen patients with a mean age of 3.8 yearswere studied for a period of 18 months. We observed amean (SD) change in PaCO2 from 66.8 (18.08) mm Hg to46.48 (5.9) mm Hg after CPAP (P=.16) and a mean changein the PaO2/FiO2 ratio from 201 (111) to 262 (115) afterCPAP (P=.30). The mean heart rate fell from 156 (22)beats/min to 127 (18) beats/min (P=.05) and the meanrespiratory rate from 53 (15) breaths/min to 33 (13)breaths/min (P<.05). No severe complications wererecorded and tolerance was satisfactory. The techniquewas considered a success in 12 patients (75%).CONCLUSIONS: CPAP without a ventilator, through aMapleson D circuit, can be used with a high success rateto provide noninvasive ventilation for pediatric patientswith acute respiratory failure (AU)
Subject(s)
Humans , Male , Female , Child , Continuous Positive Airway Pressure/instrumentation , Respiratory Insufficiency/therapy , Prospective Studies , Respiratory Insufficiency/complications , Respiration, Artificial/methodsABSTRACT
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