Outcomes of Noninvasive Positive Pressure Ventilation via RAM Cannula in Pediatric Intensive Care: A Preliminary Report

Background: Experience in the use of noninvasive positive pressure ventilation (NIPPV) via RAM cannula in the Pediatric Intensive Care Unit (PICU) is limited. Objective: The objective of this study is to describe the characteristics, outcomes, and complications of patients receiving NIPPV via RAM cannula in our PICU. Methods: A 12-month (Jan–Dec 2024) retrospective cohort study included 60 children (1 month–18 years) who received NIPPV via RAM cannula. Patients undergoing elective intubation, with do-not-resuscitate orders or with incomplete records, were excluded. Initial NIPPV settings were PEEP 5–12 cm H₂O, inspiratory pressure 15–28 cm H₂O, and FiO₂ titrated to maintain SpO₂ ≥ 92%. NIPPV failure was defined as escalation to invasive ventilation. Data were analyzed using STATA. Result: A total of 60 were included with a median age of 15.6 months (IQR 7–41.5). Admitting diagnosis were respiratory illnesses (36; 60%), cardiac disease (9; 15%), and sepsis with MODS (6; 10%). NIPPV indications include respiratory distress in 42 (70%) patients and postextubation support in 18 (30%) patients. Success was achieved in 44 patients (73.3%). Failure was associated with comorbidities (adjusted OR 0.024, p = 0.010), higher PRISM III scores (adjusted OR 0.745, p = 0.008), higher PEEP (9.8 vs. 8.4 cm H₂O, p = 0.018), and FiO₂ (90.6% vs. 60.9%, p < 0.001). A higher SF ratio was associated with success (189 vs. 136, p < 0.001). Failures had more pneumothorax (31% vs. 2.3%, p = 0.001), longer PICU stay. (18.3 vs. 8.9 days, p < 0.001), and 50% mortality rate, with no deaths among successful cases. Conclusion: NIPPV is an effective respiratory support modality in the PICU. Predictors of success are lower illness severity, no comorbidities, and better oxygenation.