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Utilisation of RAM cannula for non-invasive respiratory support for infants in the cardiac ICU

Published online by Cambridge University Press:  05 April 2021

Ashish Saini ,
Kevin O. Maher  and
Shriprasad R. Deshpande Open the ORCID record for Shriprasad R. Deshpande [Opens in a new window]
Ashish Saini
Affiliation:
Children’s Healthcare of Atlanta, Emory University, Atlanta, GA, USA
Kevin O. Maher
Affiliation:
Sibley Heart Center Cardiology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA, USA
Shriprasad R. Deshpande*
Affiliation:
Pediatric Cardiology, Children’s National Hospital, George Washington University, Washington, DC, USA
*
Author for correspondence: S. R. Deshpande, MBBS MS, Heart Transplant and Advanced Cardiac Therapies Program, Children’s National Heart Institute, 111, Michigan Avenue NW, Washington, DC20010, USA. Tel: +404 694 7739; Fax: +1-202-476-5700. E-mail: [email protected]
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Abstract

Background:

Children with CHD carry an additional burden of pulmonary insufficiency, often necessitating prolonged ventilatory support, especially in the peri-operative phase. There has been an increase in the utilisation of non-invasive ventilatory support for these children. The objective of this study was to evaluate the utilisation, safety, and outcomes of RAM cannula as a tool for escalation and de-escalation of respiratory support in paediatric cardiac patients less than one year of age.

Methods:

A single-centre retrospective cohort study of patients supported with RAM cannula.

Results:

A total of 275 instances of RAM use were included in the study, 81.1% being post-operative. Patients were stratified into escalation and de-escalation cohorts based on the indication of non-invasive ventilation. The success rate of using RAM cannula was 69.5% overall, 66.1% in the escalation group, and 72.8% in the de-escalation group. At baseline, age at cardiac ICU admission >30 days, FiO2 ≤ 40%, PaCO2 ≤ 50 mmHg; and after 12 hours of non-invasive ventilation support respiratory rate ≤ 60/min, PaO2 ≥ 50 mmHg, PaCO2 ≤ 50 mmHg; and absence of worsening on follow-up chest X-ray predicted the success with a sensitivity of 95% in the logistic regression model. Successful support was associated with a significantly shorter unit stay.

Conclusions:

RAM cannula can be safely used to provide non-invasive support to infants in the cardiac ICU for escalation and de-escalation of respiratory support. Factors associated with success can be used to make decisions about candidacy and appropriate timing of non-invasive ventilation use to maximise effectiveness.

Keywords

Non-invasive ventilationRAM cannulacardiorespiratory failurechildrencardiac intensive care post-operative care
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 12 , December 2021 , pp. 1907 - 1913
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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References

Healy, F, Hanna, BD, Zinman, R. Pulmonary complications of congenital heart disease. Paediatr Respir Rev 2012; 13: 10–15.CrossRefGoogle ScholarPubMed
Tabib, A, Abrishami, SE, Mahdavi, M, Mortezaeian, H, Totonchi, Z. Predictors of prolonged mechanical ventilation in pediatric patients after cardiac surgery for congenital heart disease. Res Cardiovasc Med 2016; 5: e30391.10.5812/cardiovascmed.30391CrossRefGoogle ScholarPubMed
Shi, S, Zhao, Z, Liu, X, et al. Peri-operative risk factors for prolonged mechanical ventilation following cardiac surgery in neonates and young infants. Chest 2008; 134: 768–774.10.1378/chest.07-2573CrossRefGoogle Scholar
Morley, SL. Non-invasive ventilation in paediatric critical care. Paediatr Respir Rev 2016; 20: 24–31.Google ScholarPubMed
Jenkins, KJ, Gauvreau, K, Newburger, JW, Spray, TL, Moller, JH, Iezzoni, LI. Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 2002; 123: 110–118.CrossRefGoogle ScholarPubMed
Rivera, R, Tibballs, J. Complications of endotracheal intubation and mechanical ventilation in infants and children. Crit Care Med 1992; 20: 193–199.CrossRefGoogle ScholarPubMed
Pinhu, L, Whitehead, T, Evans, T, Griffiths, M. Ventilator-associated lung injury. Lancet 2003; 361: 332–340.CrossRefGoogle ScholarPubMed
Ben-Abraham, R, Efrati, O, Mishali, D, et al. Predictors for mortality after prolonged mechanical ventilation after cardiac surgery in children. J Crit Care 2002; 17: 235–239.CrossRefGoogle ScholarPubMed
Fernandez Lafever, S, Toledo, B, Leiva, M, et al. Non-invasive mechanical ventilation after heart surgery in children. BMC Pulm Med 2016; 16: 167.10.1186/s12890-016-0334-xCrossRefGoogle ScholarPubMed
Romans, RA, Schwartz, SM, Costello, JM, et al. Epidemiology of non-invasive ventilation in pediatric cardiac ICUs. Pediatr Crit Care Med 2017; 18: 949–957.CrossRefGoogle ScholarPubMed
Newnam, KM, McGrath, JM, Estes, T, Jallo, N, Salyer, J, Bass, WT. An integrative review of skin breakdown in the preterm infant associated with nasal continuous positive airway pressure. J Obstet Gynecol Neonatal Nurs 2013; 42: 508–516.10.1111/1552-6909.12233CrossRefGoogle ScholarPubMed
Nzegwu, NI, Mack, T, DellaVentura, R, et al. Systematic use of the RAM nasal cannula in the Yale-New Haven Children’s Hospital Neonatal Intensive Care Unit: a quality improvement project. J Matern Fetal Neonatal Med 2015; 28: 718–721.CrossRefGoogle ScholarPubMed
Drescher, GS, Hughes, CW. Comparison of interfaces for the delivery of non-invasive respiratory support to low birthweight infants. Respir Care 2018; 63: 1197–1206.10.4187/respcare.05978CrossRefGoogle Scholar
Kovacikova, L, Skrak, P, Dobos, D, Zahorec, M. Non-invasive positive pressure ventilation in critically ill children with cardiac disease. Pediatr Cardiol 2014; 35: 676–683.CrossRefGoogle Scholar
Gupta, P, Kuperstock, JE, Hashmi, S, et al. Efficacy and predictors of success of non-invasive ventilation for prevention of extubation failure in critically ill children with heart disease. Pediatr Cardiol 2013; 34: 964–977.CrossRefGoogle ScholarPubMed