Eficácia do uso da ventilação não invasiva em pré escolares com insuficiência respiratória: Uma revisão sistemática

Abstract

Introduction: Respiratory compromise can lead to a condition of respiratory failure in children, with one of the types being acute respiratory failure, in which there are sudden changes in the clinical condition within hours or days, incapacitating the body from compensating for physiological changes that, through acid-base imbalance, lead to a more severe form of the disease. Non-invasive ventilation is indicated in some cases of Acute Respiratory Failure to avoid the use of invasive mechanical ventilation that may lead the patient to possible intubation. However, the effects of Non-Invasive Ventilation on pediatric patients with Acute Respiratory Failure are still not well-documented, with low-quality evidence available. Objective: Assessing the effectiveness of mechanical ventilation in improving the respiratory pattern of children with respiratory failure. Materials and methods: A systematic review of randomized clinical trials and cohort studies was conducted to evaluate the effectiveness of ventilation in preschool children of both sexes with Acute Respiratory Failure, aiming at outcomes of improvement in respiratory pattern and shorter hospitalization time. Searches were conducted in the databases BVS, MEDLINE, PubMed, Scopus Preview, SciELO, Science Direct, controlled register of trials, grey literature, and through manual search. Four outcomes were evaluated: efficacy, success, failure, and mortality of NIV use in preschool children, with significant improvements observed in heart and respiratory rate patterns, technique success, and mortality rates, which were described as unrelated to the use of NIV. Risk of bias assessment was performed using RoB 2.0 for clinical trials and ROBINS-I for cohort studies. The GRADE approach was used to assess the quality of evidence. Results and discussion: Three articles were included, two of which are Randomized Clinical Trials and one Prospective Cohort Study, together comprising a sample of 2,260 children aged 3 months to 9 years who were hospitalized and received assistance through Non-Invasive Ventilation, using CPAP and BiPAP devices with Nasal Cannula, Nasal Prong, Helmet, and Facial Mask interfaces. Treatment was administered over periods of 5 months, 24 months, and 36 months. After treatment, a significant improvement in patients' vital signs (such as saturation, heart rate, and respiratory rate) was observed before and after application. Regarding safety, minimal adverse effects were presented and could be addressed during the studies. Technical failure was described in a single study, with two patients experiencing airway obstruction and irritable bleeding from the airways with muscle weakness. Mortalities described in the studies were not related to the use of NIV. All outcomes showed very low to low-quality evidence. Conclusion: The findings of this review indicate that NIV is a safe and effective technique for treating Respiratory Failure; however, since the certainty of evidence is low, further studies should be conducted to increase the confidence level of the results.