• Juan Mayordomo-Colunga, Martí Pons, Yolanda López, M José Solana, Corsino Rey, Pablo Martínez-Camblor, Antonio Rodríguez-Núñez, Jesús López-Herce, Alberto Medina, Clara Abadesso, M Angeles García-Teresa, Mirella Gáboli, Milagros García-López, María González-Sánchez, Paula Madurga-Revilla, Amelia González-Calvar, and Eider Oñate.
• Department of Paediatrics, Hospital San Agustín Avilés, Asturias, Spain. jmcolunga@hotmail.com
• Intensive Care Med. 2013 Jun 1;39(6):1095-103.

PurposeOur objective was to assess whether SpO₂/FiO₂ (SF) ratio could be a useful NIV outcome predictor in children with acute respiratory failure (ARF) and tried to develop a predictive model of NIV failure.MethodsProspective, observational, multicenter study. Episodes of ARF-fulfilling inclusion criteria from 15 January 2010 to 14 January 2011 were treated with NIV according to a pre-established protocol. Clinical variables were collected at baseline and at 1, 2, 6, 12 and 24 h. Failure criterion was the need for endotracheal intubation. Failures were considered as "early" if occurring ≤6 h after NIV initiation, "intermediate" if occurring between 6 and 24 h, and "late" if occurring after 24 h. Variables with a p < 0.1 in univariate analysis corrected by age were included in multivariate analysis. Models were calculated based on multivariate analysis.ResultsDuring the study period, 390 episodes were included. NIV success rate was 81.3 %. Among ARF causes, failure occurred most frequently in ARDS episodes. The failure predictive model for the whole sample included SF ratio at 1 h, age and PRISM III-24 (area under the curve AUC of 0.755). For early NIV failures, SF ratio at 1 h was the only variable within model (AUC 0.748). The analysis of intermediate NIV failures identified 3 variables independently linked to NIV outcome: PRISM III-24, RR decrease at 6 h, and SF ratio at 6 h (AUC 0.895). No model was identified for late NIV failure.ConclusionsSF ratio is a reliable predictor of early NIV failure in children.

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