Noninvasive positive pressure ventilation in the treatment of pediatric status asthmaticus

Noninvasive positive pressure ventilation (NPPV) has been used successfully in adults with respiratory failure due to asthma. Its use in pediatric status asthmaticus is currently undefined. The aim of this study was to evaluate the effect of NPPV in acute, severe asthma. Fifteen patients with status asthmaticus admitted to the Pediatric Intensive Care Unit. Baseline tidal breathing patterns were measured by respiratory inductive plethysmography. NPPV was performed using a noninvasive ventilator (BiPAP) through a nasal mask. The NPPV was applied at two settings to find optimal pressures. The subjects were evaluated during application of NPPV and after discontinuation. There were no complications from NPPV. After initiation of therapy, there were statistically significant reductions in respiratory rate from 30.6 ± 7.4/min to 21.9 ± 7.2/min (mean ± SD, p = 0.002), fractional inspired time(T _i/T_tot) from 0.42 ± 0.04 to 0.38 ± 0.048 (p = 0.01) and rib cage-abdominal phase angle (φ) from 35.7 ± 23.3° to 18.7 ± 12.8° (p = 0.02). After cessation of therapy, these variables returned to their pre-NPPV values. There was a positive correlation between the reduction in φ and the initial φ (Spearman r = 0.63, p = 0.011). NPPV is a safe and effective treatment of status asthmaticus in pediatric patients.