QATAR CRITICAL CARE CONFERENCE ABSTRACT
Promoting NIV using ICEMAN
methodology
Manu Sundaram1, Ashwath Ram2, Alberto Medina3, Marti Pons-Odena4
Address for Correspondence:
Manu Sundaram
1
Paediatric Critical Care Unit, Sidra Medical and
Research Center, Doha, Qatar
2
Paediatric Critical Care Unit, Manipal Hospital,
Bangalore, India
3
Paediatric Critical Care Unit, Hospital
Universitario Central de Asturias, Asturias, Spain
4
Paediatric Critical Care Unit, Hospital Sant Joan
de Deu, Barcelona, Spain
Email: msundaram@sidra.org
http://dx.doi.org/10.5339/qmj.2019.qccc.24
Submitted: 25 June 2019
Accepted: 9 July 2019
ª 2019 Sundaram, Ram, Medina,
Pons-Odena, licensee HBKU Press. This is an
open access article distributed under the terms
of the Creative Commons Attribution license
CC BY 4.0, which permits unrestricted use,
distribution and reproduction in any medium,
provided the original work is properly cited.
Cite this article as: Sundaram M, Ram A,
Medina A, Pons-Odena M. Promoting
NIV using ICEMAN methodology, Qatar
Medical Journal, Qatar Critical Care
Conference 2019:24 http://dx.doi.
org/10.5339/qmj.2019.qccc.24
ABSTRACT
One of the main reasons for children
needing hospital admission is the need
for respiratory support and monitoring.
Intubation and ventilation has been the
standard method of supporting patients
in respiratory failure. With better
ventilators and interfaces many of these
children with respiratory failure could
benefit from non-invasive ventilation (NIV).
The main advantages of NIV over its invasive
counterpart are reduced need for sedation,
avoiding laryngeal and tracheal injuries,
reducing nosocomial infections, and shorter
length of stay.1,2
NIV can be used for acute conditions. Studies
have shown that NIV is more successful in
type 2 respiratory failure compared to type 1
respiratory failure as in type 2 respiratory
failure, a failing pump is replaced by another
pump i.e., NIV machine.3,4
With improvement in technology NIV
has emerged as a core therapy in the
management of patients with acute and
chronic respiratory failure. Use of NIV has not
spread worldwide. Even in the countries
where they are being used, there is huge
variability in the use of NIV. This reluctance in
usage could be partly explained by the lack of
adequate scientific literature in children
concerning this technology.
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 Promoting NIV using ICEMAN methodology
Figure 1. ICEMAN algorithm.
The first thing to do to overcome this
barrier is to create an understanding and
familiarity of this technology, resulting in
more usage of NIV which has been shown to
improve the quality of care and reduce cost
of healthcare.
A FAST-NIVT (Forwarding Advanced
Simulation Training in Noninvasive
Ventilation Therapy) project supported by
the Respiratory group of ESPNIC
(European Society of Pediatric and Neonatal
Intensive Care) has developed blended
courses (online and face to face) for
attendees and for NIV trainers in order to
promote the teaching and learning of NIV
around the world.
As an extension of this project we have
developed a structured algorithm with the
acronym ICEMAN (Figure 1) and used it to
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Sundaram et al.
train our clinicians in the judicious selection of
patients, contraindications and equipment
used for NIV.2 This approach helps the teams
to recognize failure of non-invasive
ventilation, troubleshoot hypercapnia and
hypoxemia, manage asynchrony and plan for
weaning or escalation of care using
algorithms.
We have conducted workshops globally
to provide clinicians with best practice
recommendations and guidance about how
to best deliver non-invasive ventilation to
patients who sometimes need this lifesaving
technology. By attending this workshop,
delegates would be able to understand the
various indications, NIV options, modes of
delivery, effective monitoring, and analysing
failures which will definitely go a long way in
providing this care more effectively with less
failure.
Promoting NIV using ICEMAN methodology
All the workshops are led by trained
educators who are experienced practicing
paediatric intensivists, neonatologists, and
pulmonologists with an extensive NIV
experience. To make learning fun and to
encourage participation, high-quality learning
materials and skill stations have been tailored
to the needs of each group. This
REFERENCES
1. Medina A, Pons M, Martinón-Torres F.
Non-invasive ventilation in pediatrics. Madrid:
Ergon; 2015.
2. Ram A, Sundaram M. Noninvasive ventilation in
children. In: Udani S, Muralidharan J, eds. IAP
Specialty Series on PEDIATRIC INTENSIVE CARE.
3rd ed. Delhi: Jaypee Publishers; 2019.
3. Dohna-Schwake C, Stehling F, Tschiedel E,
Wallot M, Mellies U. Non-invasive ventilation
Sundaram et al.
methodology has been successfully used to
train the next generation of clinical
champions.
Keywords: noninvasive ventilation,
respiratory failure, children, paediatrics,
pulmonology
on a pediatric intensive care unit: feasibility,
efficacy, and predictors of success. Pediatric
Pulmonol. 2011;46(11):1114– 1120.
4. Mayordomo-Colunga J, Medina A, Rey C,
Díaz JJ, Concha A, Los Arcos M, Menéndez S.
Predictive factors of non invasive ventilation
failure in critically ill children: a prospective
epidemiological study. Intensive Care Med.
2009;35(3):527– 536.
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