PURPOSE: Endotracheal intubation and mechanical ventilation are frequently undertaken in children with status asthmaticus and impending respiratory failure. However, the use of positive pressure for pediatric status asthmaticus is thought to be associated with the development of extrapulmonary air leaks. Non-invasive positive pressure ventilation (NPPV) has been used as an alternative intermediary therapy in some children. The purpose of this study was to determine if the mode of positive pressure delivery per se affects the likelihood of development of an extrapulmonary air leak.
METHODS: We retrospectively examined data from all children older than two years admitted to the ICU with status asthmaticus between April, 1997 and April, 2006.
RESULTS: Of the 271 children admitted to the ICU with status asthmaticus, 45 (17%) received treatment with positive pressure ventilation: 11 received only NPPV, 27 were intubated and mechanically ventilated, and 7 children received both of these therapies. For the children who received both therapies, only 1 of 7 was intubated after starting NPPV, the remainder received NPPV following extubation. Relatively few children overall (n=9 or 3%) developed an extrapulmonary air leak during their hospitalization: 55% had a pneumothorax and 45% had a pneumomediastinum. Compared with those not requiring positive pressure, children receiving positive pressure were significantly more likely to develop an extrapulmonary air leak during hospitalization (13% vs. 1%; p=0.001). However, the incidence of an air leak did not significantly differ according to the mode of positive pressure delivery: 9% in those who received only NPPV, 15% in those who were intubated, and 14% in those who received both therapies (p=0.89).
CONCLUSION: The use of positive pressure is associated with an increased risk of developing an extrapulmonary air leak in this population. The use of non-invasive positive pressure ventilation does not seem to significantly reduce the risk of this complication.
CLINICAL IMPLICATIONS: Although non-invasive ventilation may represent an alternative to intubation in this population that potentially prevents intubation in some children, barotrauma still remains a significant risk.
DISCLOSURE: Christopher Carroll, None.