Non-invasive ventilation practices in children across Europe.

Objectives: To describe the diversity in practice in non-invasive ventilation (NIV) in European pediatric intensive care units (PICUs).

Working Hypothesis: No information about the use of NIV in Pediatrics across Europe is currently available, and there might be a wide variability regarding the approach.

Study Design: Cross-sectional electronic survey.

Methodology: The survey was distributed to the ESPNIC mailing list and to researchers in different European centers.

Results: One hundred one units from 23 countries participated. All respondent units used NIV. Almost all PICUs considered NIV as initial respiratory support (99.1%), after extubation (95.5% prophylactically, 99.1% therapeutically), and 77.5% as part of palliative care. Overall NIV use outside the PICUs was 15.5% on the ward, 20% in the emergency department, and 36.4% during transport. Regarding respiratory failure cause, NIV was delivered in pneumonia (97.3%), bronchiolitis (94.6%), bronchospasm (75.2%), acute pulmonary edema (84.1%), upper airway obstruction (76.1%), and in acute respiratory distress syndrome (91% if mild, 53.1% if moderate, and 5.3% if severe). NIV use in asthma was less frequent in Northern European units in comparison to Central and Southern European PICUs (P = 0.007). Only 47.7% of the participants had a written protocol about NIV use. Bilevel NIV was applied mostly through an oronasal mask (44.4%), and continuous positive airway pressure through nasal cannulae (39.8%). If bilevel NIV was required, 62.3% reported choosing pressure support (vs assisted pressure-controlled ventilation) in infants; and 74.5% in older children.

Conclusions: The present study shows that NIV is a widespread technique in European PICUs. Practice across Europe is variable.