Safety of aerosol therapy in children during noninvasive ventilation with helmet and total face mask

Med Intensiva (Engl Ed). 2019 Nov;43(8):474-479. doi: 10.1016/j.medin.2018.06.003. Epub 2018 Jul 27.
[Article in English, Spanish]

Abstract

Purpose: To evaluate the consequences of using nebulized drugs in patients subjected to noninvasive ventilation (NIV) with total face mask (TFM) and helmet.

Design: A descriptive analytical study of a prospective patient cohort was carried out.

Ambit: Pediatric intensive care unit (PICU) of a tertiary hospital.

Patients: Consecutive sampling was used to include all patients admitted to the PICU and requiring NIV with helmet or TFM over a period of 29 months. No patients were excluded.

Interventions: Nebulized treatment was added according to medical criteria.

Variables of interest: Independent variables were age, sex, diagnosis, disease severity, ventilation parameters and nebulized drugs (if administered). Secondary outcomes were duration and failure of NIV, and length of PICU stay.

Results: The most frequent diagnoses were bronchiolitis (60.5%) and asthma (23%). Patients received NIV for a median of 43h. Nebulized drugs were administered in 40% of the cases during NIV, and no adverse effects were registered. Using Bayesian statistics, the calculated probability of suffering an adverse effect was 1.3% with helmet and 0.5% with TFM (high density 95% probability intervals). Patients with helmet and nebulized therapy were in more serious condition than those who did not receive nebulization; nevertheless, no differences were observed regarding the need to change to bilevel modality. With TFM, PICU stay was shorter for the same degree of severity (p=0.033), and the NIV failure rate was higher in patients who did not receive inhaled drugs (p=0.024).

Conclusions: The probability of suffering an adverse effect related to nebulization is extremely low when using a helmet or TFM. Inhaled therapy with TFM may shorten PICU stay in some patients.

Keywords: Asma; Asthma; Bronchial spasm; Bronchiolitis; Broncoespasmo; Bronquiolitis; Casco; Drug side effect; Efectos secundarios; Helmet; Mascarilla facial total; Nebulización; Nebulizers and vaporizers; Noninvasive ventilation (NIV); Total face mask; Ventilación no invasiva (VNI).

MeSH terms

  • Administration, Inhalation
  • Asthma / drug therapy
  • Bronchial Spasm / drug therapy
  • Bronchiolitis / drug therapy
  • Bronchodilator Agents / administration & dosage*
  • Child, Preschool
  • Head Protective Devices*
  • Humans
  • Infant
  • Intensive Care Units, Pediatric
  • Length of Stay
  • Masks*
  • Multivariate Analysis
  • Nebulizers and Vaporizers*
  • Noninvasive Ventilation / adverse effects
  • Noninvasive Ventilation / methods*
  • Noninvasive Ventilation / statistics & numerical data
  • Pneumonia / drug therapy
  • Prospective Studies
  • Respiration, Artificial / statistics & numerical data
  • Statistics, Nonparametric
  • Tertiary Care Centers
  • Time Factors

Substances

  • Bronchodilator Agents