Non-invasive positive pressure ventilation (NIPPV) has been used safely and effectively to improve gas exchange and to treat respiratory failure in a variety of disease states. While this technique has some benefits in the treatment of asthma exacerbations in adults, the use of NIPPV in pediatric patients with asthma has not been described.
Retrospective chart and data review of children admitted to the ICU with asthma who received NIPPV as part of their treatment between October 2002 and April 2004. Before and after initiation of NIPPV, data were collected regarding degree of respiratory dysfunction with parameters including respiratory rate, gas exchange and a clinical asthma score, the Modified Pulmonary Index Score (MPIS).
Of seventy-nine children admitted to the ICU during the study period for treatment of status asthmaticus, five children (6%) were treated with NIPPV. The mean age was 9.6 + 4.2 years. Four of the five children were morbidly obese with a mean Body Mass Index of 32 + 5. Indications for the use of NIPPV were increased work of breathing (n=5) and hypoxia (n=3). There was a statistically significant improvement in respiratory rate (43 + 20 vs. 31 + 12 breaths/min, p=0.03) and MPIS (13.4 + 1.8 vs. 11.4 + 1.5, p=0.03) between 30-60 minutes after initiation of NIPPV. There was no significant change in hemodynamic parameters after initiation of NIPPV. Children received NIPPV for a mean duration of 33.2 + 23.9 hours. There were no reported complications from the NIPPV and children tolerated this therapy well, requiring little or no anxiolytics.
NIPPV is well tolerated in children with status asthmaticus and can improve subjective and objective measures of respiratory dysfunction. Morbidly obese children with status asthmaticus appear to comprise a population that is particularly prone to improve with NIPPV.
NIPPV may be a useful adjunct in the treatment of status asthmaticus in children, especially if they are obese.
C.L. Carroll, None.