Efficacy and Predictors of Noninvasive Ventilation in neonates with congenital heart disease

doi:10.21203/rs.3.rs-4699277/v1

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Efficacy and Predictors of Noninvasive Ventilation in neonates with congenital heart disease

https://doi.org/10.21203/rs.3.rs-4699277/v1

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Background: To evaluate the outcomes of noninvasive ventilation (NIV) therapy in neonates with congenital heart disease at our institute, and identify predictors associated with noninvasive ventilation therapy.

Methods: We examined 207 neonates who underwent cardiac surgery at a single institution from 2018 to 2023. Relevant data, such as demographic information, operative details, and postoperative records, were gathered from medical and surgical records. Our primary focus was on the NIV failure.

Results: Median age and weight at surgery were 12(6-19) days and 3.3 (2.9-3.6) kg, respectively. 86(41.5%) patients were extubated to NIV (NIV group), and 121(58.5%) were not experienced NIV (No-NIV group). In NIV group, 47 (57.4%) were assigned to the preventive group and 39 (47.3%) to the non-preventive group. The NIV failure rate was 6.8% (14/86) and mortality rate was 2.4% (n=5). According to multivariate logistic regression analysis PaCO2>37.5mmHg at pre-extubation and requirement for emergent resuscitation before surgery were the independent predictors associated with NIV therapy, the duration of postoperative mechanical ventilation (MV), PaCO2 value at 24h post-extubation and vasoactive-inotropic score (VIS) influenced the occurrence of NIV failures, and there were more NIV failure happened after 24 hours of NIV therapy (8/14, 57.1%). For the patients with longer aortic cross‑clamp time, higher PCO2 value at pre-extubation and required peritoneal dialysis after surgery were more likely to receive preventive NIV therapy.

Conclusions: NIV can be successfully used in neonates who after cardiac surgery. For patients at risk, the preventive NIV therapy could more effective in avoiding NIV failure.

extubation

noninvasive ventilation

neonatal cardiac surgery

risk factors

NIV failure

The use of noninvasive ventilation (NIV) therapies has been on the rise for providing respiratory support to children with congenital heart disease (CHD). Previous studies have demonstrated that NIV is a secure and efficient choice for infants and children undergoing cardiac surgery [1]. In comparison to invasive mechanical ventilation (IMV), NIV offers superior support and reduces the need for endotracheal intubation while also lowering the risk of complications such as pneumonia or ventilator-induced lung injury (VILI) [2]. Factors such as low pH, pulmonary parenchymal disease, high heart rate, elevated respiratory rate, and pulmonary hypertension have been linked to NIV failure [3–5], with failure rates nearing 30% [6]. Nevertheless, research on the use of NIV in neonates following cardiac surgery remains limited.

In this context, our attention was directed towards a more uniform cohort of individuals - specifically neonates undergoing cardiac surgical procedures. Our primary objective was to assess the determinants for NIV utilization and to scrutinize the variables linked to NIV inefficacy within this specific patient demographic. Additionally, we aimed to appraise the rationales and effectiveness of preventive NIV intervention in this subset of patients.

Study population

A retrospective cohort study at Beijing Anzhen Hospital examined cardiac surgeries for neonates born from Jan 2018 to Dec 2023. The study (No. No.2024077X, titled “Noninvasive Ventilation in neonates with congenital heart disease: a retrospective cohort study”) was conducted in accordance with the Declaration of Anzhen Hospital, and was approved by the Ethics Committee of Anzhen Hospital in 2024 (No. 2024077X), and the requirement for informed consent was waived. Procedures were conducted following the ethical standards of the responsible committee as per the Helsinki Declaration of 1975. Only patients under 28 days old at the time of cardiac surgery were included. And those who died prior to extubation or those who failed weaning from invasive mechanical ventilation and received tracheotomy were excluded from the study.

Data Collection

Patient information was obtained retrospectively from medical records with only the first intervention analyzed. Demographic and perioperative data were collected, including sex, age, weight, gestational age (GA), and preoperative medical data. Surgical procedure complexity was assessed using The Society of Thoracic Surgeons–European Association for Cardio-thoracic Surgery Congenital Heart Surgery (STAT) mortality scores. The data collected during surgery included details about the procedure performed, the duration of cardiopulmonary bypass and aortic cross clamp. After surgery, the data collected included how long mechanical ventilation was required, the vasoactive-inotropic score, length of stay (LOS) in the ICU, LOS in hospital, delayed sternal closure, extracorporeal membrane oxygenation (ECMO) use, extubation failure, and whether there were any major postoperative complications.

In addition, the following data were collected at pre-extubation, post-extubation(30min after extubation) and at initiating, 4, 12, and 24 h of NIV: heart rate (HR), respiratory rate (RR), arterial blood gas analysis (pH, PaO2, PaCO2), the ratio of partial pressure of arterial oxygen/ fraction of inspired oxygen (PaO2/FiO2, OI). Data reviewed also included ventricular ejection fraction (EF) and mean peak airway pressure at the time of extubation (PIP), interval time from extubation to NIV, the total NIV duration, complications attributed to NIV (such as gastric distension, nasal trauma, pneumothorax and pneumome-diastinum), use of sedatives, mortality, and causes of death.

The primary outcome was success or failure of NIV. The secondary outcomes were the ICU LOS, the hospital LOS, the mortality rate, and improvement in respiratory and hemodynamic parameters.

Definitions

Definitions for the study included hospital mortality (death prior to hospital discharge), NIV failure (requiring intubation), extubation failure (unplanned reintubation within 72 hours of planned first extubation), residual lesion (residual shunt or obstruction, moderate or severe regurgitation), unplanned reoperation (reoperation during the postoperative period, except for bleeding), arrhythmia requiring therapy (any arrhythmia needing drugs, electrical cardioversion, or defibrillation). A vasoactive-inotropic score (VIS) is used to quantify the amount of inotropic support provided in the postoperative period [7].

The patients were divided into the NIV group and the no-NIV group, depending on whether NIV assistance has been provided after extubation. In the NIV group, patients were classified into a preventive group if NIV was initiated immediately after extubation, and into a non-preventive group if NIV was initiated after the onset of signs and symptoms of ARF development; Furthermore, we divided them into successful and failed groups based on the success or failure of NIV.

Statistical analysis

The study utilized the Statistical Package for Social Sciences (SPSS) 25.0 software (SPSS Inc, Chicago, IL, USA) and GraphPad Prism 6 (GraphPad Software, Inc, La Jolla, CA, USA) for statistical analysis. Demographics, patient characteristics, and outcomes were expressed as median (interquartile range) or frequency (%), depending on the variable type. Categorical variables were tested using χ2, while numeric variables were evaluated using Mann–Whitney U tests. Non-parametric data were assessed using the Kruskal–Wallis test for more than two groups. Univariate and multivariate logistic regression analyses were conducted to determine significant predictors of mortality and prolonged mechanical ventilation, presented as OR and 95%CI. The predictive accuracy of PaCO2 was explored using receiver operating characteristic (ROC) curves and relative area under the curve (AUC), and the cutoff point was examined for sensitivity and specificity. A significance level of P < 0.05 was considered for all statistical analyses.

The main characteristics of the patients

From 2018 to 2023, there were 207 neonates who underwent cardiac surgery. 64.7% (134) were male, and the gestational age was 39 (38–39) weeks. Of these patients, 8.7% (18) had a gestational age < 37 weeks, the mean age at surgery was 12(6–19) days, and the mean weight at surgery was 3.3 (2.9–3.6) kg. the baseline characteristics and diagnosis are shown in Supplemental Table 1.

The outcome of NIV group Versus No-NIV group

Of the 207 patients, 86(41.5%) patients were extubated to NIV, forming the NIV group, while 121(58.5%) were not experienced NIV after extubation, comprising the No-NIV group. The comparison of baseline characteristics between the NIV group and No-NIV group is summarized in Supplemental Table 2.

In the NIV group, the duration of NIV was 48.0(24.0–72.0) hours. There were 14(16.3%) patients experienced NIV failure, and the hospital mortality was 2.4%(n = 5). All were on IMV with orotracheal intubation at the time of death, 4 patients died due to sepsis and 1patient died due to heart failure.

Patients who did experienced NIV were more likely require emergent resuscitation or vasoactive support before surgery, and more emergent intervention. Additionally, more patients in NIV group experienced NIV or IMV support before surgery. The NIV group also showed prolonged bypass time, aortic cross‑clamp time, the duration of postoperative mechanical ventilation, ICU LOS and hospital LOS. Additionally, the incidence of ECMO use, peritoneal dialysis, extubation failure were also more common in the NIV group (p < 0.05) (Supplementary Material, Table S2). With the exception of EF, HR, RR, PO2, PaO2/FiO2, and Lac at the time of pre-extubation, most of the respiratory and hemodynamic parameters in NIV group and No-NIV group were also different in our study (Table 1). The independent predictors associated with NIV therapy included pre-extubation PaCO2 levels exceeding 37.5mmHg and the need for emergent resuscitation preoperatively (p < 0.05) (Table 2). Notably, no instances of gastric distension impeding NIV application, pneumothorax, or pneumomediastinum occurred during NIV therapy. Patients receiving NIV were consistently administered sedative therapy as part of the standard protocol.

Table 1

The respiratory and hemodynamic parameters in NIV group and No-NIV group
parameter	NIV group(n = 86)	No-NIV group(n = 121)	P value
Pre-extubation mean peak airway pressure, cmH₂O	14.5(13.0–17.0)	14.0(13.0–15.0)	0.011
Pre-extubation PCO2, mmHg	40.0(38.3–42.4)	36.2(33.9–38.8)	0.000
Pre-extubation PO2, mmHg	96.2(63.4-151.3)	116.0(75.9–157.0)	0.167
Pre-extubation pH	7.45(7.43–7.48)	7.47(7.43–7.50)	0.032
Pre-extubation OI, mmHg	184.2(120.4-287.5)	216.7(139.1-291.4)	0.310
Pre-extubation lac, mmol/L	1.5(1.2-2.0)	1.5(1.1–2.1)	0.501
Post-extubation PCO2, mmHg	40.8(36.9–47.1)	37.4(34.2–40.0)	0.000
Post-extubation PO2, mmHg	83.2(57.8-147.8)	143.0(97.1-211.5)	0.000
Post-extubation pH	7.41(7.38–7.45)	7.45(7.43–7.48)	0.000
Post-extubation OI, mmHg	314.1(177.6-418.7	619.0(423.8-983.3)	0.000
Pre-extubation EF, %	68.0(65.0–72.0)	66.0(62.5–73.0)	0.548
Pre-extubation HR, beats per min	151.0(140.0-160.0)	150.0(138.5–160.0)	0.647
Pre-extubation RR, breaths per min	37.5(30.8–42.3)	36.0(30.0–40.0)	0.381

Table 2

Multivariate Predictors of NIV Application
Variable	β	OR	95% CI	AUC (%)	Cut-off value	p value
Pre-extubation PCO2, mmHg	0.224	1.251	1.144–1.367	0.837	37.5	0.000
Preoperative emergent resuscitation	1.117	3.057	1.068–8.749			0.037

Of the patients using NIV, the first extubation attempt failed in 14(16.3%) patients after the extubation for the following reasons: respiratory dysfunction (n = 6), upper airway obstruction (n = 3), diaphragm paralysis (n = 2), cardiac dysfunction (n = 3). During the study, 11 patients occurred in the non-preventive group, and 3 patients occurred in the preventive group (28.2% vs. 6.4% p = 0.006). Following unsuccessful extubation, three patients underwent diaphragm plication, while the remaining 11 patients required further therapeutic management of their respiration and circulation.

Univariate analysis indicated that most demographic and surgical-related characteristics had no effect on success or failure rates. And the duration of postoperative MV, duration of NIV, pH value at pre-extubation, PaCO2 value at 24h after extubation, VIS, and the occurrence of atelectasis were different. And multivariate analysis revealed that the duration of postoperative MV, PaCO2 value at 24h post-extubation and VIS influenced the occurrence of failures (Table 3).

Table 3

Univariable and multivariable logistic analyses of risk factors for NIV failure
	Univariable analysis		Multivariable analysis
	OR (95% CI)	P Value	OR (95% CI)	P Value
Age at surgery, days	0.938(0.864–1.017)	0.121
Male, n (%)	0.800(0.251–2.555)	0.706
Weight, Kg	0.906(0.331–2.478)	0.848
<37 wk, n(%)	0.000(0.000–0.000)	0.999
STAT, n (%)	0.857(0.081–9.097)	0.898
Preoperative Airway disease, n(%)	1.815(0.492-6.700)	0.371
Preoperative vasoactive support, n (%)	0.752(0.214–2.643)	0.657
Preoperative respiratory support, n(%)	0.714(0.135–3.774)	0.692
Aortic cross‑clamp time, minutes	0.993(0.979–1.008)	0.348
Bypass time, minutes	1.000(0.991–1.008)	0.950
Postoperative mechanical ventilation, hours	1.006(1.002–1.101)	0.001	1.004(1.001–1.007)	0.004
NIV, hours	1.015(1.001–1.028)	0.029
Pre-extubation mean airway pressure, cmH2O	1.026(0.802–1.311)	0.841
Pre-extubation PH	0.000(0.000-0.388)	0.034
Pre-extubation PCO2, mmHg	1.105(0.988–1.235)	0.079
24h Post-extubation PCO2, mmHg	1.096(1.023–1.174)	0.009	1.128(1.025–1.243)	0.014
VIS	1.090(1.023–1.162)	0.008	1.101(1.005–1.205)	0.038
Atelectasis, n (%)	5.000(1.420-17.606)	0.012

The outcome of the preventive group and non-preventive group

In NIV group, 47 (57.4%) were assigned to the preventive group and 39 (47.3%) to the non-preventive group. In non-preventive group, the duration from extubation to NIV was 7.0(2.0–20.0) hours.

The preventive group and non-preventive group were not differed significantly in age at surgery, body weight, and overall pre-surgery condition. There were no significant differences in cardiac variables between the two groups. Univariate analysis and multivariate analysis revealed that the patients with longer aortic cross‑clamp time, higher PCO2 value at pre-extubation and required peritoneal dialysis after surgery were more likely to receive preventive NIV therapy (Table 4).

Table 4

Univariable and multivariable logistic analyses of preventive group and non-preventive group
	Univariable analysis		Multivariable analysis
	OR (95% CI)	P Value	OR (95% CI)	P Value
Age at surgery, days	0.993(0.938–1.051)	0.808
Male, n(%)	1.111(0.448–2.758)	0.820
Weight, Kg	0.784(0.351–1.751)	0.553
<37 wk, n(%)	1.500(0.367–6.133)	0.573
STAT, n (%)	4.167(0.696–24.936)	0.118
Preoperative Airway disease, n (%)	0.918(0.317–2.660)	0.874
Preoperative vasoactive support, n (%)	1.027(0.401–2.627)	0.956
Preoperative respiratory support, n (%)	0.771(0.245–2.431)	0.658
Aortic cross‑clamp time, minutes	1.018(1.005–1.032)	0.007	1.024(1.008–1.040)	0.003
Bypass time, minutes	1.012(1.003–1.020)	0.008
Postoperative mechanical ventilation, hours	1.003(0.999–1.006)	0.098
NIV, hours	0.989(0.978–1.001)	0.062
Pre-extubation mean airway pressure, cmH2O	0.878(0.723–1.067)	0.191
Pre-extubation PCO2, mmHg	1.208(1.068–1.366)	0.003	1.242(1.085–1.421)	0.002
Pre-extubation pH	0.000(0.000-0.885)	0.047
Post-extubation OI, mmHg	0.999(0.998–1.001)	0.271
Peritoneal dialysis, n (%)	6.632(1.421–30.942)	0.016	7.005(1.392–35.251)	0.018
Extubation failure, n (%)	0.174(0.044–0.677)	0.012

Although the duration of NIV (48.0 [23.0–72.0] hours vs. 48.0[24.0–74.0], p = 0.209), and the ICU LOS (12.0 [9.0-15.5] days vs. 14.0[12.0–20.0], p = 0.157) were no different in the preventive group and non-preventive group, the hospital LOS (15.0 [12.0–19.0] days vs. 20.0[14.5–25.5], p = 0.011) was shorter in the preventive group.

In the non-preventive group, the duration of extubation to NIV assistance was no different in failure and success group (18.0[12.0–20.0] hours vs. 10.5[4.0-23.5] hours, p = 0.221), but the duration of NIV was longer in the failure group than in the success group (72.0[40.0-133.0] hours vs. 47.0[22.5–62.3] hours, p = 0.043). In the preventive group, the duration of NIV was no different between failure and success group (32.0[4.0–48.0] hours vs. 48.0[22.0–72.0] hours, p = 0.390).

The NIV failure rate was significantly higher in non-preventive group than preventive group (28.2%[n = 11] vs. 6.4%[n = 3], p = 0.006), and the mortality rate in non-preventive group was comparatively higher than that of preventive group, but the difference was not statistically significant (10.8% vs. 2.0%, p = 0.085).

The failure rates within 12h hour of preventive group and non-preventive group were 33.3% (n = 1), and 9.1% (n = 1) (P = 0.287), whin 24h was 66.7% (n = 2) and 18.2% (n = 2), and after 24h were 0.0% (n = 0.099) and 72.7% (n = 8) respectively (P = .024).

The changes of respiratory rate, and heart rate were not different between preventive group and non-preventive group (Fig. 1–2). Compared with patients in non-preventive group, the pH, OI and PaO2 were lower at the time of post-extubation, but the changed from initiation to 24 hours of NIV therapy were not different (Fig. 3–5). After 12h of NIV, in the non-preventive group, the arterial PCO2 were increased significant compared with baseline values post-extubation (Fig. 6).

The research outcomes presented herein demonstrate that the implementation of preventive NIV therapy exhibited efficacy in averting extubation failure, thereby resulting in decreased length of hospital stay.

NIV has demonstrated its efficacy in the therapy of several causes of ARF in the postoperative period of cardiovascular surgeries, both in children and adults [8]. Traditionally, patients undergoing postoperative cardiac surgery and experiencing ARF were managed with IMV [9]. Nevertheless, the utilization of NIV as an alternate form of respiratory support for neonates with CHD is not yet firmly established. While appropriate administration of NIV can potentially avert respiratory failure, cardiac arrest, and other significant complications [10–12], unwarranted use of NIV may prolong intensive care treatment, heighten exposure to invasive procedures and medications, thereby posing potential risks to patients [13–14].

Previous study suggested that age, the existence of extracardiac anomalies, surgical complexity, as well as prolonged mechanical ventilation before the first extubation attempt and evidence of airway disease, may be associated with the use of NIV therapy [15]. However, there is a lack of detailed explanation regarding this in the neonatal population. Our investigation revealed that elevated PaCO2 levels exceeding 37.5mmHg pre-extubation and the need for preoperative emergent resuscitation were the most significant independent predictors for the application of NIV therapy.

During cardiopulmonary bypass, reduced blood flow to organs can induce an elevation in inflammatory mediators and cells systemically. Consequently, the likelihood of complications, such as alveolar collapse, atelectasis, acute respiratory failure, and pulmonary infections due to increased pulmonary interstitial exudation, is heightened [16–17]. This can lead to impaired lung ventilation function, manifested by elevated PaCO2 levels. Patients with a history of preoperative resuscitation may exhibit more intricate cardiopulmonary pathophysiology and organ dysfunction, necessitating prolonged support for adequate oxygenation and ventilation. In essence, patients with elevated PCO2 levels or a history of emergent preoperative resuscitation may benefit significantly from non-invasive ventilation therapy.

Our study yielded a significant discovery indicating that the rate of NIV failure remained stable in patients receiving preventive NIV therapy. And after comparing preventive group and non-preventive group, we found that the preventive NIV therapy was beneficial for shortening hospital LOS, and rehabilitation of critically ill patients.

Our results suggested that application of preventive NIV therapy immediately after extubation could decrease the rate of reintubation, improved hypoxemia and pulmonary ventilation compared with non-NIV therapy group.

Previous research has found that preventive NIV therapy had a higher success rate for children than for children in a non- preventive NIV therapy (81% vs. 50%, p = 0.037) [18]. But preventive NIV therapy is not yet the standard of care, and it is unclear whether preventive therapy is superior to non-preventive in preventing extubation failure and other clinical outcomes.

Patients undergoing cardiac surgery face significant respiratory challenges due to changes in hemodynamics and systemic inflammation following cardiopulmonary bypass. Following surgery, muscle weakness and diaphragmatic fatigue are common, impeding respiratory recovery post-extubation [19]. Premature and low birth weight infants exhibit increased airway resistance and air trapping, affecting lung function [20].

NIV exhibits promising capabilities in reducing upper airway resistance, preserving alveolar functional residual capacity, and averting alveolar collapse, which in turn enhances alveolar ventilation [21–22]. Furthermore, NIV has the capacity to alleviate respiratory burden through the conditioning of airflow entering the nasopharynx, thereby reducing effort [23]. In patients with congenital heart disease, NIV may induce fluctuations in lung volume and intrathoracic pressure, impacting preload, afterload, heart rate, and myocardial contractility. In this context, the application of positive end-expiratory pressure (PEEP) helps maintain pressures above atmospheric levels throughout the respiratory cycle, leading to decreased left ventricle afterload, ultimately resulting in improved hemodynamics and enhanced cardiac output [24]. The proactive implementation of NIV demonstrates positive outcomes in ameliorating fragile cardiopulmonary function postoperatively in neonates following cardiac surgery, as evidenced by previous experiences.

Our retrospective analysis revealed a significant increase in arterial PaCO2 levels after 12 hours of NIV compared to baseline values (post-extubation) in the non-preventive group. Additionally, a higher rate of failure was observed after 24 hours, particularly in the non-preventive group. Previous studies have indicated that post-extubation atelectasis is commonly observed in 10–30% of patients within the initial 24 hours post-extubation [25], while short-term NIV usage has shown to enhance lung function within the same timeframe. Furthermore, NIV has been shown to improve PaCO2 levels in postoperative patients undergoing thoracic surgery [26–27].

By integrating these findings with our own retrospective study, it can be inferred that preventive NIV therapy may effectively reduce carbon dioxide levels in the early stages, prevent NIV failure, and promote prompt recovery.

In paediatric intensive care, the rate of NIV failed ranges from 4.1 to 14% [28]. Hence, it is crucial to identify the early risk factors that can lead to failure of NIV to prevent the need for emergency or delayed reintubation [29–30]. Some studies have emphasized the importance of monitoring parameters such as the increase of RR, blood pressure and/or oxygen demand as possible risk factors of NIV failure [31]. Further research on respiratory parameters found that the absence of improvement in PaO2/FiO2 at hours 12 and pH < 7.36 at hour 1 after extubation were predictive factors of NIV failure [32], and the high RR at 1–2 hours of NIV was also a strong risk factor with NIV failure in ARDS patients [33].

Not surprisingly, we found the prolonged mechanical ventilation was one of the independent risk factors of NIV failure that was same with other study [34]. We also found that the PCO2 at 24h has a strong correlation with NIV failure, and that was also consistent with the phenomenon that most patients experience NIV failure after 24 hours of NIV therapy.

To optimize outcomes for high-risk patients, maintaining a higher PEEP level (above 6–8 cm H2O) is crucial for improving gas exchange, preserving functional residual capacity, preventing regional atelectasis, and reducing airway resistance. In addition, monitoring the patient's consciousness level and utilizing modern sedation agents like dexmedetomidine can enhance patient cooperation and promote effective patient-ventilator synchrony [35].

In conclusion, NIV can be safely and successfully applied for neonate with CHD. The independent predictors for NIV use include arterial blood gas PaCO2>37.5mmHg at pre-extubation and preoperative emergent resuscitation. Meanwhile, aortic cross‑clamp time, pre-extubation PCO2 and peritoneal dialysis after surgery were associate with preventive NIV therapy. Additionally, the failure of NIV more happened after 24h from NIV therapy, and were associated with the duration of postoperative MV, PaCO2 value at 24h post-extubation. At last, the preventive NIV therapy could reduce the extubation failure rates compared with the non-preventive NIV therapy, and the successful application of NIV requires the involvement of a complete multidisciplinary team.

Limitations

This study is subject to certain limitations, including a retrospective study design and a small case volume. And due to insufficient work experience, some clinical data was missing. Hence, future studies with larger sample sizes would be invaluable. In order to fully validate our thesis, randomized clinical studies and multicenter studies are needed.

NIV noninvasive ventilation

CHD congenital heart disease

MV mechanical ventilation

VIS vasoactive-inotropic score

VILI ventilator-induced lung injury

GA gestational age

STAT The Society of Thoracic Surgeons–European Association for Cardio-thoracic Surgery Congenital Heart Surgery

LOS length of stay

ECMO extracorporeal membrane oxygenation

HR heart rate

RR respiratory rate

OI the ratio of partial pressure of arterial oxygen/ fraction of inspired oxygen

EF ventricular ejection fraction

PIP peak airway pressure

Ethics Approval and Consent to Participate：

All subjects gave their informed consent for inclusion before they participated in the study. The study was approved by the Ethics Committee of Anzhen Hospital in 2024 (No. 2024077X), and the requirement for informed consent was waived. Procedures were conducted following the ethical standards of the responsible committee as per the Helsinki Declaration of 1975.

Consent for publication: Written informed consent for publication was obtained from all participants.

Availability of data and materials: All data generated or analysed during this study are included in this published article.

Competing interests: The authors declare that they have no conflicts of interest to report regarding the present study.

Funding Statement: This work was supported by the Capital’s Funds For Health Improvement And Research under Grant 2024-1-2062.

Author Contributions: QW designed the research study. HZ and GL performed the research. QL, YZ and JS analyzed the data. All authors contributed to editorial changes in the manuscript. All authors read and approved the final manuscript.

Acknowledgment: We would like to express our gratitude to all those who helped us during the writing of this manuscript. Thanks to all the peer reviewers for their opinions and suggestions.

Ryan AR, Steven MS, John MC, et al. Epidemiology of Noninvasive Ventilation in Pediatric Cardiac ICUs. Pediatr Crit Care Med. 2017.18(10):949-957.
Dean R Hess. Noninvasive ventilation for acute respiratory failure. Respir Care. 2013. 58(6):950-72.
Frat JP, Ragot S, Coudroy R, et al. Predictors of intubation in patients with acute hypoxemic respiratory failure treated with a noninvasive oxygenation strategy. Crit Care Med. 2018.46(2):208–15.
Carrillo A, Gonzalez‑Diaz G, Ferrer M, et al. Non‑invasive ventilation in community‑acquired pneumonia and severe acute respiratory failure. Intensive Care Med. 2012.38(3):458–66.
Thille AW, Contou D, Fragnoli C, et al. Non‑invasive ventilation for acute hypoxemic respiratory failure: intubation rate and risk factors. Crit Care. 2013.17(6): R269.
Romans RA, Schwartz SM, Costello JM et al. Epidemiology of noninvasive in pediatric cardiac ICUs. Pediatr Crit Care Med. 2017.18(10):949-957.
Gaies MG, Jeffries HE, Niebler RA, et al. Vasoactive-inotropic score is associated with outcome after infant cardiac surgery: Ananalysis from the pediatric cardiac critical care consortium and virtual PICU system registries. Pediatr Crit Care Med. 2014. 15:529–537.
Yañez LJ, Yunge M, Emilfork M et al. A prospective, randomized, controlled Trial of noninvasive ventilation in pediatric acute respiratory failure. Pediatr Crit Care Med. 2008. 9(5):1–5.
Preecha T, Surat T, Withaya T, et al. Factors predicting failure of noninvasive ventilation assist for preventing reintubation among medical critically ill patients. J Crit Care. 2017. 38:177-181.
Zhu X, Qi H, Feng Z, et al. Nasal Oscillation Post-Extubation (NASONE) Study Group. Noninvasive high-frequency oscillatory ventilation vs nasal continuous positive airway pressure vs nasal intermittent positive pressure ventilation as Post-extubation support for preterm neonates in China: a randomized clinical trial. JAMA Pediatr. 2022. 176(6):551-559.
Lee BK, Shin SH, Jung YH, et al. Comparison of NIV-NAVA and NCPAP in facilitating extubation for very preterm infants. BMC Pediatr. 2019. 19(1):298.
Denise SR, Filomena RB, Lucilia SF. Use of Noninvasive Ventilation in Respiratory Failure After Extubation During Postoperative Care in Pediatrics. Pediatr Cardiol. 2020. 41(4):729-735.
Céline F, Valérie B, Judith H. Nasal trauma due to continuous positive airway pressure in neonates. Arch Dis Child Fetal Neonatal Ed. 2010.95(6): F447-51.
Drescher GS, Hughes CW. Comparison of interfaces for the delivery of noninvasive respiratory support to low birthweight infants. Respir Care. 2018. 10:1197–206.
Gupta P, Kuperstock JE, Hashmi S, et al. Efficacy and predictors of success of noninvasive ventilation for prevention of extubation failure in critically ill children with heart disease. Pediatr Cardiol. 2013. 34:964–977.
Karacalilar M, Onan IS, Onan B, et al. Effects of pulmonary perfusion during cardiopulmonary bypass on lung functions after cardiac operation. J Card Surg. 2020. 35(10):2469-2476.
Lin X, Ma X, Cui X, et al. Effects of erythropoietin on lung injury induced by cardiopulmonary bypass after cardiac surgery. Med Sci Monit. 2020. 20:26: e920039.
Mayordomo-Colunga J, Medina A, Rey C, et al. Noninvasive ventilation after extubation in paediatric patients: a preliminary study. BMC Pediatr. 2010. 5:10:29.
Mayordomo-Colunga J, Medina A, Rey C, et al. Predictive factors of non invasive ventilation failure in critically ill children: a prospective epidemiological study. Intensive Care Med. 2009. 35:527-536.
Letizia C, Angela CB, Julia Cerullo, et al. Reducing post-extubation failure rates in very preterm infants: is BiPAP better than CPAP? J Matern Fetal Neonatal Med. 2022.35(7):1272-1277.
Gizzi C, Montecchia F, Panetta V, et al. Is synchronized NIPPV more effective than NIPPV and NCPAP in treating apnea of prematurity (AOP)? A randomized cross-over trial. Arch Dis Child Fetal Neonatal Ed. 2015. 100(1): F17-23.
Alexiou S, Panitch HB. Physiology of noninvasive respiratory support.Semin Fetal Neonatal Med. 2016. 21(3):174-180.
Tao W, Lixi Z, Kai Luo, et al. Noninvasive versus invasive mechanical ventilation for immunocompromised patients with acute respiratory failure: a systematic review and meta-analysis. BMC Pulm Med. 2016. 27;16(1):129.
Guarracino F, Cabrini L, Baldassarri R, et al. Non-invasive ventilation-aided transoesophageal echocardiography in high-risk patients: a pilot study. Eur J Echocar-diogr . 2010. 11(6):554-556.
Nur BC, Murat T, Filiz Y, et al. Comparison of high flow oxygen therapy versus noninvasive mechanical ventilation for successful weaning from invasive ventilation in children An observational study. Medicine (Baltimore). 2022. 30;101(39): e30889.
Zoremba M, Kalmus G, Begemann D, et al. Short-term noninvasive ventilation post surgery improves arterial blood-gases in obese subjects compared to supplemental oxygen delivery - a randomized controlled trial. BMC Anesthesiol. 2011. 11(1):1-8.
Tobias JD. Noninvasive ventilation using bi-level positive airway pressure to treat impending respiratory failure in the postanesthesia care unit. J Clin Anesth. 2000. 12(5):409-412.
Ilari K, Mikko U. Noninvasive respiratory support preventing reintubation after pediatric cardiac surgery-A systematic review. Paediatr Anaesth. 2024. 34(3):204-211.
Mastropietro CW, Cashen K, Grimaldi LM, et al. Extubation failure after neonatal cardiac surgery: A multicenter analysis. J Pediatr. 2017. 182:190–6.
Miura S, Hamamoto N, Osaki M, et al. Extubation failure in neonates after cardiac surgery: Prevalence, etiology, and risk factors. Ann Thorac Surg. 2017. 103:1293–8.
Poletto E, Cavagnero F, Pettenazzo M, et al. Ventilation Weaning and Extubation Readiness in Children in Pediatric Intensive Care Unit: A Review. Front Pediatr. 2022. 10:867739.
Lubica K, Peter S, Dusan D, et al. Noninvasive positive pressure ventilation in critically ill children with cardiac disease. Pediatr Cardiol. 2014. 35(4):676-83.
Weiwei S, Shuliang G, Fuxun Y, et al. Association between ARDS Etiology and Risk of Noninvasive Ventilation Failure. Ann Am Thorac Soc. 2022. 19(2):255-263.
Miquel F, Jacobo S Antoni T. Noninvasive ventilation in withdrawal from mechanical ventilation. Semin Respir Crit Care Med. 2014. 35(4):507-18.
Andrew B, Tarik A, Syed Ali, et al. Modern Sedation and Analgesia Strategies in Neurocritical Care. Curr Neurol Neurosci Rep. 2023. 23(4):149-158.

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Reviewers agreed at journal
25 Aug, 2024
Reviewers invited by journal
22 Aug, 2024
Editor assigned by journal
25 Jul, 2024
First submitted to journal
16 Jul, 2024

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Efficacy and Predictors of Noninvasive Ventilation in neonates with congenital heart disease

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Abstract

Figures

Introduction

Materials and Methods

Study population

Data Collection

Definitions

Statistical analysis

Results

The main characteristics of the patients

The outcome of NIV group Versus No-NIV group

The outcome of the preventive group and non-preventive group

Discussion

Conclusion

Abbreviations

Declarations

References

Supplementary Files

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Version 1