Mayordomo-Colunga et al. BMC Pediatrics 2010, 10:29 http://www.biomedcentral.com/1471-2431/10/29 Open Access RESEARCH ARTICLE BioMed Central © 2010 Mayordomo-Colunga et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Cre- ative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and re- production in any medium, provided the original work is properly cited. Research article Non invasive ventilation after extubation in paediatric patients: a preliminary study Juan Mayordomo-Colunga*, Alberto Medina, Corsino Rey, Andrés Concha, Sergio Menéndez, Marta Los Arcos and Irene García Abstract Background: Non-invasive ventilation (NIV) may be useful after extubation in children. Our objective was to determine postextubation NIV characteristics and to identify risk factors of postextubation NIV failure. Methods: A prospective observational study was conducted in an 8-bed pediatric intensive care unit (PICU). Following PICU protocol, NIV was applied to patients who had been mechanically ventilated for over 12 hours considered at high- risk of extubation failure -elective NIV (eNIV), immediately after extubation- or those who developed respiratory failure within 48 hours after extubation -rescue NIV (rNIV)-. Patients were categorized in subgroups according to their main underlying conditions. NIV was deemed successful when reintubation was avoided. Logistic regression analysis was performed in order to identify predictors of NIV failure. Results: There were 41 episodes (rNIV in 20 episodes). Success rate was 50% in rNIV and 81% in eNIV (p = 0.037). We found significant differences in univariate analysis between success and failure groups in respiratory rate (RR) decrease at 6 hours, FiO 2 at 1 hour and PO 2 /FiO 2 ratio at 6 hours. Neurologic condition was found to be associated with NIV failure. Multiple logistic regression analysis identified no variable as independent NIV outcome predictor. Conclusions: Our data suggest that postextubation NIV seems to be useful in avoiding reintubation in high-risk children when applied immediately after extubation. NIV was more likely to fail when ARF has already developed (rNIV), when RR at 6 hours did not decrease and if oxygen requirements increased. Neurologic patients seem to be at higher risk of reintubation despite NIV use. Background Conventional mechanical ventilation (CMV) is a core fea- ture of intensive care. Weaning and removement of endo- tracheal tube are crucial processes, which often account for a considerable part of CMV total time. Unsuccessful extubation has been noted to be associated with an increase of both morbidity and mortality in adult and paediatric patients [1-4]. The documented rate of failed extubations ranges from 4.1 to 14% in paediatric intensive care units (PICUs) [1,2,5]. Therefore, strategies prevent- ing the need for reintubation are needed. Non invasive ventilation (NIV) has been proposed as a useful therapy to wean patients after unsuccessful wean- ing trials and to avoid reintubation in adults [6-10], though controversy exists at this concern [11,12]. This technique is increasingly being used in paediatric patients over the last years [13-20]. Some of these studies have included children receiving NIV because of ARF second- ary to multiple causes including postextubation cases [13,14]. Other authors, however, excluded from the anal- ysis postextubation NIV use [15-17] in accordance with NIV studies in adult patients and very low birth infants, which analyze postextubation NIV separately [6,8-10,21- 23]. The reason provided to exclude these cases is that NIV characteristics are very different when applied after receiving CMV. The objective of the present study was to determine postextubation NIV characteristics and to identify risk factors of postextubation NIV failure in children. Methods A prospective observational study was conducted in our 8-bed paediatric intensive care unit (PICU) from July * Correspondence: jmcolunga@hotmail.com 1 Paediatric Intensive Care Unit. Department of Paediatrics. Hospital Universitario Central de Asturias. University of Oviedo. Oviedo. Spain Full list of author information is available at the end of the article