Olugbenga A. Akingbola1, Narong Simakajornboon, Edwin F. Hadley Jr, Robert L. Hopkins. 1. Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA (OAA, NS, RLH), and the Health Care Sciences Medical Center of Louisiana, Louisiana State University, New Orleans, LA (OAA, NS, EFH, RLH). E-mail: oakingb@tulane.edu
Abstract
OBJECTIVE: To describe the use of noninvasive positive-pressure ventilation in children with status asthmaticus. DESIGN: Brief report. SETTING:Pediatric intensive care unit in two tertiary institutions. SUBJECTS:Children with severe acute asthma and hypercarbic respiratory failure. INTERVENTIONS:Noninvasive positive-pressure ventilation using a bilevel positive-pressure (BIPAP) device. MEASUREMENTS AND MAIN RESULTS:Three children, ages 9, 11, and 15 yrs, were treated for hypercarbic respiratory failure caused by status asthmaticus by using BIPAP. The duration of pediatric intensive care unit admission was 48 hrs, and the duration of therapy ranged from 12 to 17 hrs. Inspiratory positive airway pressure ranged from 10 to 14 cm H(2)O (0.98-1.37 kPa), with a mean of 12 cm H(2)O (1.18 kPa). Expiratory positive airway pressure ranged from 4 to 5 cm H(2)O (0.39-0.49 kPa), with a mean of 5 cm H(2)O (0.49 kPa). Pulse oximetry was monitored continuously until resolution of symptoms. The mean values for respiratory rate, pH, and CO(2) tension were compared at initiation, 3-4 hrs, and >12 hrs after beginning BIPAP. BIPAP treatment resulted in improved ventilatory status as shown by an increase in pH from a mean of 7.26 on admission to 7.38 after 3-4 hrs and after 12 hrs, respectively. However, respiratory rate showed a steady decrease from a mean of 31.7 breaths/min on admission to 24 breaths/min at 3-4 hrs and 19 breaths/min at >12 hrs of BIPAP therapy. CO(2) tension (Pco(2)) decreased from a mean value of 54.6 mm Hg (7.28 kPa) on admission to 36.4 mm Hg (4.85 kPa) at 3-4 hrs of treatment; the mean Pco(2) after >12 hrs of treatment was 39.8 mm Hg (5.31 kPa). CONCLUSION: In three children with status asthmaticus, BIPAP seemed to improve ventilation and gas exchange, culminating in resolution of hypercarbic respiratory failure. A prospective, randomized, and controlled study is required to determine its role in pediatric status asthmaticus.
RCT Entities:
OBJECTIVE: To describe the use of noninvasive positive-pressure ventilation in children with status asthmaticus. DESIGN: Brief report. SETTING: Pediatric intensive care unit in two tertiary institutions. SUBJECTS:Children with severe acute asthma and hypercarbic respiratory failure. INTERVENTIONS: Noninvasive positive-pressure ventilation using a bilevel positive-pressure (BIPAP) device. MEASUREMENTS AND MAIN RESULTS: Three children, ages 9, 11, and 15 yrs, were treated for hypercarbic respiratory failure caused by status asthmaticus by using BIPAP. The duration of pediatric intensive care unit admission was 48 hrs, and the duration of therapy ranged from 12 to 17 hrs. Inspiratory positive airway pressure ranged from 10 to 14 cm H(2)O (0.98-1.37 kPa), with a mean of 12 cm H(2)O (1.18 kPa). Expiratory positive airway pressure ranged from 4 to 5 cm H(2)O (0.39-0.49 kPa), with a mean of 5 cm H(2)O (0.49 kPa). Pulse oximetry was monitored continuously until resolution of symptoms. The mean values for respiratory rate, pH, and CO(2) tension were compared at initiation, 3-4 hrs, and >12 hrs after beginning BIPAP. BIPAP treatment resulted in improved ventilatory status as shown by an increase in pH from a mean of 7.26 on admission to 7.38 after 3-4 hrs and after 12 hrs, respectively. However, respiratory rate showed a steady decrease from a mean of 31.7 breaths/min on admission to 24 breaths/min at 3-4 hrs and 19 breaths/min at >12 hrs of BIPAP therapy. CO(2) tension (Pco(2)) decreased from a mean value of 54.6 mm Hg (7.28 kPa) on admission to 36.4 mm Hg (4.85 kPa) at 3-4 hrs of treatment; the mean Pco(2) after >12 hrs of treatment was 39.8 mm Hg (5.31 kPa). CONCLUSION: In three children with status asthmaticus, BIPAP seemed to improve ventilation and gas exchange, culminating in resolution of hypercarbic respiratory failure. A prospective, randomized, and controlled study is required to determine its role in pediatric status asthmaticus.
Authors: Abby M Williams; Thomas J Abramo; Malee V Shah; Renee A Miller; Cheryl Burney-Jones; Samantha Rooks; Cristina Estrada; Donald H Arnold Journal: Intensive Care Med Date: 2011-05-13 Impact factor: 17.440
Authors: Juan I Muñoz-Bonet; Eva M Flor-Macián; Patricia M Roselló; Mari C Llopis; Alicia Lizondo; José L López-Prats; Juan Brines Journal: World J Pediatr Date: 2010-06-12 Impact factor: 2.764
Authors: Juan Mayordomo-Colunga; Alberto Medina; Corsino Rey; Juan José Díaz; Andrés Concha; Marta Los Arcos; Sergio Menéndez Journal: Intensive Care Med Date: 2008-11-04 Impact factor: 17.440
Authors: Steven L Shein; Richard H Speicher; José Oliva Proença Filho; Benjamin Gaston; Alexandre T Rotta Journal: Rev Bras Ter Intensiva Date: 2016-06
Authors: Florent Baudin; Alexandra Buisson; Blandine Vanel; Bruno Massenavette; Robin Pouyau; Etienne Javouhey Journal: Ann Intensive Care Date: 2017-05-22 Impact factor: 6.925