Clinical and Laboratory Predictors of Continuous Positive Airway Pressure Failure in Pediatric Intensive Care Unit Patients: A Retrospective Study

Abstract

Continuous positive airway pressure (CPAP) is widely used in pediatric intensive care units (PICUs) to manage acute respiratory distress in conditions such as bronchiolitis, pneumonia, asthma exacerbations, and post-extubation support. While CPAP reduces the need for invasive mechanical ventilation (MV), a proportion of patients experience CPAP failure, necessitating escalation to MV. Early identification of predictors of CPAP failure is essential to optimize outcomes. This study aimed to determine the rate and timing of CPAP progression in PICU patients, identify clinical and laboratory predictors of CPAP failure, and compare outcomes between patients with different CPAP durations. A retrospective cohort study was conducted by reviewing medical records of children aged 1 month to 16 years admitted to the PICU over a 12–24-month period. Data collected included demographics, admission diagnosis, vital signs, CPAP settings, arterial blood gas parameters, lactate, and C-reactive protein (CRP). Outcomes assessed were CPAP success or failure, time to failure, length of PICU stay, and mortality. Statistical analyses included descriptive statistics, chi-square and t tests, logistic regression to identify predictors, and Kaplan–Meier survival analysis for time to intubation. Most patients progressed within 2–3 days of CPAP support. Prolonged CPAP (>3 days) was associated with higher complication rates, longer PICU stay, and increased mortality. Predictors of CPAP failure included lower weight, acidosis, hypercapnia, elevated lactate, and raised CRP. Early recognition of clinical and laboratory predictors of CPAP failure can guide timely escalation to invasive ventilation, reduce complications, and improve pediatric critical care outcomes.