Non-invasive mechanical ventilation in children: a four-year retrospective review

Introduction : Non-invasive ventilation (NIV) is becoming more common in the treatment of respiratory failure in children, but its effectiveness varies with the severity of the underlying disease. Aim : The study’s objective was to assess, over a four-year period, the indications, physiological effects, and clinical outcomes of NIV in children admitted to a pediatric intensive care unit (PICU) with acute or chronic respiratory failure. Materials and methods : This retrospective, single-center study included 25 children who received NIV between 2021 and 2025. Demographic data, underlying diagnoses, type of respiratory failure, inflammatory markers, radiological findings, NIV interface, gas exchange parameters before and after NIV, and clinical outcomes were analyzed. Results : The median age was 3.9 years (range 0–17), with 68% being male. Neuromuscular disorders were the leading indication (55%), followed by primary pulmonary disease (37%). Spinal muscular atrophy type 1 was the most common specific diagnosis. Interface use was age-dependent: infants predominantly received nasal masks/prongs, while older children used oronasal or full-face masks. NIV produced significant improvements in gas exchange ( p <0.05), indicating effective correction of respiratory acidosis and hypoxemia. Radiology and inflammatory markers distinguished two clinical phenotypes. Children with primary respiratory disease, genetic syndromes, or systemic comorbidities frequently showed pneumonic infiltrates and markedly elevated CRP/PCT, indicating infection-driven respiratory failure. In contrast, neuromuscular patients demonstrated minimal inflammatory elevation and chronic or atelectatic radiographic patterns, consistent with ventilatory pump failure. The S/F ratio at initiation strongly predicted outcome: all children with an S/F ratio <150 experienced NIV failure or death, whereas those with an S/F ratio >250 showed successful recovery. NIV duration was longest in neuromuscular disorders (mean 48 days), reflecting chronic ventilatory insufficiency. Conclusion : NIV is effective in improving gas exchange in both acute and chronic respiratory failure in children. Clinical outcome depends on underlying diagnoses, inflammatory activity, radiologic pattern, and initial oxygenation status. The S/F ratio is a reliable predictor of NIV success.