Nicht-invasive Beatmung bei Kindern und Jugendlichen auf einer interdisziplinären pädiatrischen Intensivstation

摘要

Non-invasive ventilation (NIV) is defined as the use of a mask to provide ventilatory support. Avoiding endotracheal intubation and reducing the rate of complications and mortality secondary to intubation is the most important advantage. In a retrospective study we analysed the number and indications for NIV in our pediatric intensive care unit (PICU) in the last four years. We also examined the number of secondary intubations and deaths in these patients. NIV was applied either with a constant flow device (Vital-Sign) with PEEP valves from 5 to 12.5 cm H₂O or Hamilton Galileo Gold using NIV or ASV (adaptive support ventilation) mode. We used full face or nasal masks. NIV was applied in 25 patients admitted to our PICU in the last four years. Underlying diseases were haematological diseases, congenital cardiac abnormalities, cystic fibrosis, neuromuscular diseases, near drowning, polytrauma and mechanical ileus. The most frequent indications for NIV were pneumonias, the recruitment of atelectasis and pulmonary oedemas. Other indications were the support of ventilation as a palliative treatment, status asthmaticus, respiratory failure secondary to a spinal cord lesion and anticonvulsive treatment and in one patient with cystic fibrosis as a bridge to lung transplantation. Secondary intubations had to be done in 7 patients. Five of them had an underlying haematological disease with severe pneumonia and 3 of them had also ALI or ARDS. All our patients survived, except one patient with lung aspergillosis, who had to be intubated secondary and the 4 patients with end stage diseases obtaining NIV as a palliative treatment. In our opinion the NIV offers an effective and successful alternative to conventional mechanical ventilation, especially for the treatment and support of children with pneumonias, atelectasis, pulmonary oedemas and weaning from ventilation. More randomised controlled trails are required especially for patients with ALI and ARDS.