To evaluate the practice of bilevel positive airway pressure mechanical ventilation in our pediatric intinsive care unitMETHOD: Retrospective chart review.
The charts for sixteen patients (6 months to 18.5 years, mean 10.12yrs +/− 6.3), in whom bipap was used, were reviewed. 50% of the patients recived bipap for post extubation respiratory insufficiency and 31% for hypoxic respiratory insufficiency. The most frequent radiographic findings were atelectasis and pulmonary edema. Median duration of bipap was 23hrs (range 30min to 240hrs). Despite the use of bipap, 50% of the patients required endotracheal intubation, including 50% of those who were receiving bipap for post extubation respiratory insufficiency. There was a trend for decreased respiratory rate, heart rate and decrease fio2. 60% of patients required sedation either to tolerate bipap, for pain after surgical procedures, or carry over from mechanical ventilation. Only three patients were given enteral feeds. The only complication as a result of bipap recorded in 25% of patients was skin breakdown.CONCLUSIONS: Intubation rate after trial of bipap in our institution exceeds what is reported in the literature (8% - 37%). Reintubation rate was also high, despite low ventilator settings prior to extubation and the use of bipap.
There are few studies on the use of bipap in the pediatric intensive care unit. Its use, althought relative simple compared to invasive mechanical ventilation, has not been well studied in critically ill children. Prospective studies to determine which group of patients best benefits from this therapy are needed. Also, more education for intensivist, respiratory care and nursing staff is needed.
T.R. Monge, None.