Role of noninvasive ventilation in liberation from invasive mechanical ventilation in children: A single center retrospective analysis

Background: Noninvasive respiratory support (NRS) modalities are used more frequently to reduce the risk of extubation failure. We aimed to describe the role and effectiveness of noninvasive ventilation (NIV) in the liberation from invasive mechanical ventilation (IMV). Subjects and Methods: This was a retrospective database analysis of children receiving IMV for more than 48 h, admitted to a single teaching hospital’s pediatric intensive care unit (PICU) between March 2022 and September 2023. The analysis compared planned or rescue NIV or low-flow nasal cannula (LFNC), after the patient was liberated from IMV. Results: Out of 329 extubation for IMV events, 268 (81.5%) extubation events required LFNC, and 61 (18.5%) required planned NIV. Children in planned NIV group had more comorbidities (odds ratio [OR]: 2.94, 95% confidence interval [CI]: 1.07–8.05, P = 0.035), longer PICU length of stay (OR: 1.30, 95% CI: 1.09–1.55, P = 0.004), more previous extubation failures (43.5% vs. 6.3%; P < 0.001), and longer duration of previous IMV (8.5 [4–13] vs. 6 [4–8]; P = 0.007) as compared to LFNC group. The primary cause of extubation failure was severe upper airway obstruction by far. Subsequent rescue NIV was required for 52 (19.4%) postextubation events in the LFNC group. Among the NIV events, the planned NIV group had lower extubation failure rates (8.2% vs. 47.1% [24], P < 0.001) and longer respiratory support days (8 [4–13] days vs. 6 [5–8] days, P = 0.04) as compared to rescue NIV group. Conclusions: Planned NIV for IMV liberation was associated with significantly lower extubation failure rates and longer duration of respiratory support.