Bilevel positive airway pressure in the treatment of status asthmaticus in pediatrics

Objectives: The aim of this study was to examine the safety, patient tolerance, and possible benefit of bilevel positive airway pressure (BiPAP) in conjunction with β-2 agonist therapy in the treatment of pediatric patients with status asthmaticus who were refractory to conventional medical therapy. Methods: This descriptive retrospective chart review examined all patients with the diagnosis of acute asthma treated with BiPAP in an urban academic pediatric emergency department (ED) from April 1, 2003, to August 31, 2004. Results: Eighty-three patients with status asthmaticus refractory to conventional pharmacological treatment were placed on BiPAP with β-2 agonist nebulization in the ED. The number of subjects tolerating BiPAP was 73 (88%) of 83 patients. All patients placed on BiPAP in the ED were initially designated for admission to the pediatric intensive care unit (PICU). However, only 78% (57/73) were actually admitted to the PICU. Sixteen patients on BiPAP were admitted to a ward service; of these patients, none were subsequently transferred to the PICU. In addition, there was an immediate improvement in subjects' clinical status upon initiation of BiPAP, with 77% showing a decrease in respiratory rate, averaging 23.6% (range, 4%-50%), and 88% showing an improved oxygen saturation, averaging 6.6 percentage points (1-28 percentage points). There were no adverse events due to the use of BiPAP. Conclusions: These results suggest that the addition of BiPAP in treating pediatric status asthmaticus is safe and well tolerated. This intervention shows promise as a beneficial adjunct to conventional medical treatments. However, further prospective investigation is warranted to confirm these findings.