Premium
Non‐invasive ventilation in pediatric status asthmaticus: A prospective observational study
Author(s) -
MayordomoColunga Juan,
Medina Alberto,
Rey Corsino,
Concha Andrés,
Menéndez Sergio,
Arcos Marta Los,
VivancoAllende Ana
Publication year - 2011
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.21466
Subject(s) - medicine , ipratropium bromide , respiratory rate , anesthesia , salbutamol , asthma , prospective cohort study , ventilation (architecture) , intubation , observational study , respiratory distress , heart rate , bronchodilator , blood pressure , mechanical engineering , engineering
Objective Non‐invasive ventilation (NIV) has been shown to be effective in different causes of respiratory failure in both adult and pediatric patients. However, its role in status asthmaticus (SA) remains unclear. We designed a prospective study to assess the feasibility of NIV in children with SA. Study design Prospective observational study, over a 4.5‐year period. Patient selection Children with SA unresponsive to conventional therapy with a modified Wood's clinical asthma score (m‐WCAS) ≥4 and marked increased work of breathing, were included. Methodology Patients were placed on pressure support NIV. During NIV therapy, salbutamol was nebulized continuously and ipratropium bromide every 2 hr; methyl‐prednisolone was given at a dose of 1–2 mg/kg/6 hr. Clinical variables were measured at baseline and at 1, 6, 12, 24, and 48 hr. Results During the study period, there were 122 PICU admissions due to SA; 72 episodes fulfilled inclusion criteria. Baseline mean values were as follows: m‐WCAS of 5.7 points, heart rate (HR) of 166.7 beats/min, respiratory rate (RR) of 49.5 breaths/min and FiO 2 of 45.3%. In the first hour m‐WCAS fell 2.3 ± 1.5 points, HR 13.5 ± 14 beats/min, and RR 9.8 ± 10 breaths/min ( P < 0.01). After institution of NIV therapy, 5 children required intubation due to increasing respiratory distress. There was one case of massive subcutaneous emphysema, with no other serious adverse effects associated with NIV. Conclusions These results show that NIV is a feasible therapy in children with SA unresponsive to conventional treatment. Pediatr. Pulmonol. 2011; 46:949–955. © 2011 Wiley‐Liss, Inc.