Risk Factors For The Failure Of Nasal Noninvasive Ventilation In Hospitalized Infants With Severe Community Acquired Pneumonia

Objective: To investigate the risk factors for the failure of nasal noninvasive ventilation(NIV)in infants with severe community acquired pneumonia(SCAP),and further evaluate the predictive value of PELOD-2 score,PRISM III score and modified PIRO scale.Methods: This was a retrospective study in Pediatric Intensive Care Unit.Collect data of infants with SCAP who received nasal NIV from January 2017 to December 2021.According to whether the outcome of NIV was intubation,participants were divided into two groups: successful group and failure group.ROX index was the ratio of Sp O2/Fi O2 to the respiratory rate.ΔROX index was the difference between the actual ROX index and the corrected respiratory rate ROX index.The correlation between clinical data and the outcome of NIV was analyzed by using the binary logistic regression model,and applied receiver operating characteristic curve to evaluate the predictive value of the PELOD-2score,PRISM III score and the modified PIRO scale for intubation.Results: A total of 168 infants were enrolled,the failure rate of nasal NIV was 47.0%.After using a binary logistic regression model,neuromuscular disorder(OR = 6.47,95%CI:1.06-39.56),increased times of alanine transaminase(2.25,1.15-4.39),ΔROX index <-0.41(2.20,1.06-4.55),the duration before start NIV(0.97,0.94-0.99),and the initial oxygen concentration of NIV(1.05,1.02-1.09)were associated with NIV failure independently(all P values < 0.05).PRISM III score(AUC = 0.588,P = 0.049)and modified PIRO scale(AUC = 0.615,P = 0.010)could be used to predict NIV failure,and the cut-off values were both 3 points.19.0% of intubation attacked after 72 hours of admission,and the proportion of worse clinical outcomes(76.6% vs 40.0%,P = 0.011)was significantly higher than that of early intubation(within 72 hours of admission).Conclusion: The history of neuromuscular disorder,reduced ΔROX index,increased alanine transaminase and initial oxygen concentration of NIV,as well as the earlier demand of NIV were risk factors for NIV failure.PRISM III score and modified PIRO scale could be practicable in prediction intubation.