Rowan, Courtney M.Fitzgerald, Julie C.Agulnik, AsyaZinter, Matt S.Sharron, Matthew P.Slaven, James E.Kreml, Erin M.Bajwa, Rajinder P.S.Mahadeo, Kris M.Moffet, JerelynTarquinio, Keiko M.Steiner, Marie E.2022-12-152022-12-152021-05-27Rowan CM, Fitzgerald JC, Agulnik A, et al. Risk Factors for Noninvasive Ventilation Failure in Children Post-Hematopoietic Cell Transplant. Front Oncol. 2021;11:653607. Published 2021 May 27. doi:10.3389/fonc.2021.653607https://hdl.handle.net/1805/30741Rationale: Little is known on the use of noninvasive ventilation (NIPPV) in pediatric hematopoietic cell transplant (HCT) patients. Objective: We sought to describe the landscape of NIPPV use and to identify risk factors for failure to inform future investigation or quality improvement. Methods: This is a multicenter, retrospective observational cohort of 153 consecutive children post-HCT requiring NIPPV from 2010-2016. Results: 97 (63%) failed NIPPV. Factors associated with failure on univariate analysis included: longer oxygen use prior to NIPPV (p=0.04), vasoactive agent use (p<0.001), and higher respiratory rate at multiple hours of NIPPV use (1hr p=0.02, 2hr p=0.04, 4hr p=0.008, 8hr p=0.002). Using respiratory rate at 4 hours a multivariable model was constructed. This model demonstrated high ability to discriminate NIPPV failure (AUC=0.794) with the following results: respiratory rate >40 at 4 hours [aOR=6.3 9(95% CI: 2.4, 16.4), p<0.001] and vasoactive use [aOR=4.9 (95% CI: 1.9, 13.1), p=0.001]. Of note, 11 patients had a cardiac arrest during intubation (11%) and 3 others arrested prior to intubation. These 14 patients were closer to HCT [14 days (IQR:4, 73) vs 54 (IQR:21,117), p<0.01] and there was a trend toward beginning NIPPV outside of the PICU and arrest during/prior to intubation (p=0.056). Conclusions: In this cohort respiratory rate at 4 hours and vasoactive use are independent risk factors of NIPPV failure. An objective model to predict which children may benefit from a trial of NIPPV, may also inform the timing of both NIPPV initiation and uncomplicated intubation.en-USAttribution 4.0 InternationalHematopoietic (stem) cell transplantation (HCT)Noninvasive (positive pressure) ventilationRespiratory insufficiencyIntubationCardiopulmonary resuscitationArticle