Objective
To describe the use of noninvasive positive-pressure ventilation in children with status asthmaticus.
Design
Brief report.
Setting
Pediatric intensive care unit in two tertiary institutions.
Subjects
Children with severe acute asthma and hypercarbic respiratory failure.
Interventions
Noninvasive positive-pressure ventilation using a bilevel positive-pressure (BIPAP) device.
Measurements and Main Results
Three children, ages 9, 11, and 15 yrs, were treated for hypercarbic respiratory failure caused by status asthmaticus by using BIPAP. The duration of pediatric intensive care unit admission was 48 hrs, and the duration of therapy ranged from 12 to 17 hrs. Inspiratory positive airway pressure ranged from 10 to 14 cm H2O (0.98–1.37 kPa), with a mean of 12 cm H2O (1.18 kPa). Expiratory positive airway pressure ranged from 4 to 5 cm H2O (0.39–0.49 kPa), with a mean of 5 cm H2O (0.49 kPa). Pulse oximetry was monitored continuously until resolution of symptoms. The mean values for respiratory rate, pH, and CO2 tension were compared at initiation, 3–4 hrs, and >12 hrs after beginning BIPAP. BIPAP treatment resulted in improved ventilatory status as shown by an increase in pH from a mean of 7.26 on admission to 7.38 after 3–4 hrs and after 12 hrs, respectively. However, respiratory rate showed a steady decrease from a mean of 31.7 breaths/min on admission to 24 breaths/min at 3–4 hrs and 19 breaths/min at >12 hrs of BIPAP therapy. CO2 tension (Pco2) decreased from a mean value of 54.6 mm Hg (7.28 kPa) on admission to 36.4 mm Hg (4.85 kPa) at 3–4 hrs of treatment; the mean Pco2 after >12 hrs of treatment was 39.8 mm Hg (5.31 kPa).
Conclusion
In three children with status asthmaticus, BIPAP seemed to improve ventilation and gas exchange, culminating in resolution of hypercarbic respiratory failure. A prospective, randomized, and controlled study is required to determine its role in pediatric status asthmaticus.
