Proposed Implementation of a Protocol Based on the Evidence of Noninvasive Mechanical Ventilation in Critical Children

Abstract

Noninvasive mechanical ventilation (NIV) is used for patients who require ventilator support, and is increasingly used. At national health system, the demand for this kind of support is increasing.

Objective: To establish norms for application and surveillance of NIV in a tertiary health care level hospital.

Materials and Methods: Studies and documents retrieved were evaluated according to the evidence evaluation scale and graduation of recommendations postulated by the Scottish Intercollegiate Guidelines Network (SIGN); after that, the protocol was developed.We developed answers to the following questions: 1)What types of NIV are used in children?; 2) Which are the clinical or laboratory indications to start NIV?; 3) Which are the clinical or laboratory indications to start NIV in the PICU, emergency room or guards?;4)HowlongandhowoftenshouldNIV be monitored to evaluate its efficacy?;5) What are the possible complications of NIV? 6) Which are the best predictors for success or failure of NIV; 7) Which are the best indicators to evaluate NIV?; 8) Which one steps should we follow in case of failure of the NIV?; 9) Who are the people qualified for application of NIV?; 10) What kind of people and supplements are needed for NIV?; 11) What is the recommended sequence for NIV application?

Results: The protocol was developed and graduated recommendations are presented according to their level of evidence, including an algorithm and definitions.

Conclusion: A protocol for management of noninvasive ventilation in children, based to the best evidence available, is presented.