Pediatrics: Pediatric Pulmonary |

Noninvasive Ventilation in Pediatric Status Asthmaticus FREE TO VIEW

Todd Karsies, MD; Melissa Moore-Clingenpeel, MA
Author and Funding Information

OSU/Nationwide Children's Hospital, Columbus, OH

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):962A. doi:10.1016/j.chest.2016.08.1065
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SESSION TITLE: Pediatric Pulmonary

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Tuesday, October 25, 2016 at 02:45 PM - 04:15 PM

PURPOSE: Noninvasive ventilation (NIV) is increasingly used for critically ill adults and children with respiratory insufficiency or failure. Use of NIV for pediatric status asthmaticus is not well supported, and there are concerns that NIV only delays intubation and is associated with complication rates similar to invasive ventilation. NIV is frequently used in our pediatric intensive care unit (PICU) for status asthmaticus. The purpose of this study was to report our experience with NIV in pediatric status asthmaticus.

METHODS: We evaluated all patients admitted over a 1 year period to our PICU for status asthmaticus who were > 2 years old with prior history of wheezing, admitted for wheezing, and treated with continuous aerosolized albuterol. For patients with >1 admission, only the first admission was analyzed. We assessed the initial and maximal settings used on NIV. We also compared patient characteristics, illness severity, medications, and outcomes such as LOS and barotrauma between status asthmaticus patients treated with NIV and those who were not (non-NIV). Chi-square or Wilcoxon rank-sum test were used for group comparisons as appropriate. We used gamma regression to determine which factors are associated with PICU LOS.

RESULTS: 170 NIV patients were compared to 128 non-NIV patients (57% of the cohort was treated with NIV during PICU stay). Median initial inspiratory (IPAP) and expiratory (EPAP) pressures were 12 and 6 cmH2O respectively, while median peak IPAP and EPAP were 14 and 8. Maximum IPAP used in any patient was 26 while the maximum EPAP was 12. Baseline characteristics were similar between groups except NIV patients had higher asthma score at ICU admission [median (IQR) 7 (5,8) vs 6 (5,7); p=0.0116]. The number of adjunctive medications patients received was comparable [median (IQR) 1 (1,1) for both groups]; however, patients on NIV were more likely to receive ketamine [21% vs 2%, p<0.0001], aminophylline [8% vs 1%, p=0.0056], and Heliox [7% vs 1%, p=0.0086]. A total of 8 patients were intubated (2.7%), but only 3 were intubated after first being treated with NIV (1.8% of those on NIV). Only two patients had barotrauma: 1 (0.6%) NIV patient and 1 (0.8%) non-NIV patient. NIV patients did have a longer ICU LOS than non-NIV patients even when adjusting for initial asthma score and other potential confounders (adjusted mean ICU LOS 2.68 vs 1.74 days; p<0.0001). The strongest association with longer LOS was seen with invasive mechanical ventilation [risk ratio 2.63 (1.87, 3.71); p<0.0001].

CONCLUSIONS: In our cohort of children with status asthmaticus, NIV use was not associated with adverse outcomes such as barotrauma and was associated with a low rate of invasive mechanical ventilation. While increased treatment intensity and LOS likely reflect higher disease severity, prospective, controlled studies are needed to better determine the impact of NIV on pediatric status asthmaticus outcomes.

CLINICAL IMPLICATIONS: Our results suggest that NIV can safely be used in pediatric status asthmaticus without increasing barotrauma or delaying intubation.

DISCLOSURE: The following authors have nothing to disclose: Todd Karsies, Melissa Moore-Clingenpeel

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