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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: sdeshpan@childrensnational.org
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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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