Non-invasive positive pressure ventilation for acute asthma in children

Korang, Steven Kwasi; Feinberg, Joshua; Wetterslev, Jørn; Jakobsen, Janus Christian

doi:10.1002/14651858.cd012067.pub2

Cited by 30 publications

(25 citation statements)

References 90 publications

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“…This highlights the diagnostic difficulties in separating severe acute asthma from viral pneumonia in some of the cases. Current evidence does not support any positive outcome effects of noninvasive positive pressure ventilation for treatment of children with acute asthma other than symptom relief and decrease of work of breathing ( 11 ). It is still widely used, however, across ICUs worldwide, and our pathway also includes this mode of support early in the management of severe acute asthma.…”

Section: Discussionmentioning

confidence: 99%

Implementation of a Critical Care Asthma Pathway in the PICU

Miksa¹,

Kaushik²,

Antovert³

et al. 2021

Critical Care Explorations

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Objectives: Acute asthma management has improved significantly across hospitals in the United States due to implementation of standardized care pathways. Management of severe acute asthma in ICUs is less well studied, and variations in management may delay escalation and/or deescalation of therapies and increase length of stay. In order to standardize the management of severe acute asthma in our PICU, a nurse- and respiratory therapist–driven critical care asthma pathway was designed, implemented, and tested. Design: Cross-sectional study of severe acute asthma at baseline followed by implementation of a critical care asthma pathway. Setting: Twenty-six–bed urban quaternary PICU within a children’s hospital. Patients: Patients 24 months to 18 years old admitted to the PICU in status asthmaticus. Patients with severe bacterial infections, chronic lung disease, heart disease, or immune disorders were excluded. Interventions: Implementation of a nurse- and respiratory therapist–driven respiratory scoring tool and critical care asthma pathway with explicit escalation/deescalation instructions. Measurements and Main Results: Primary outcome was PICU length of stay. Secondary outcomes were time to resolution of symptoms and hospital length of stay. Compliance approached 90% for respiratory score documentation and critical care asthma pathway adherence. Severity of illness at admission and clinical baseline characteristics were comparable in both groups. Pre intervention, the median ICU length of stay was 2 days (interquartile range, 1–3 d) with an overall hospital length of stay of 4 days (interquartile range, 3–6 d) ( n = 74). After implementation of the critical care asthma pathway, the ICU length of stay was 1 day (interquartile range, 1–2 d) ( p = 0.0013; n = 78) with an overall length of stay of 3 days (interquartile range, 2–3.75 d) ( p < 0.001). The time to resolution of symptoms was reduced from a median of 66.5 hours in the preintervention group to 21 hours in the postintervention compliant group ( p = 0.036). Conclusions: The use of a structured critical care asthma pathway, driven by an ICU nurse and respiratory therapist, is associated with faster resolution of symptoms, decreased ICU, and overall hospital lengths of stay in children admitted to an ICU for severe acute asthma.

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Section: Discussionmentioning

confidence: 99%

Implementation of a Critical Care Asthma Pathway in the PICU

Miksa¹,

Kaushik²,

Antovert³

et al. 2021

Critical Care Explorations

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“…A 2016 Cochrane review concluded that the available evidence at the time was insufficient to evaluate the effect of NIV on asthma exacerbations in children and that better designed studies with larger samples size are required. 16 Anecdotal evidence suggests that NIV in asthma exacerbations may help to avoid or delay endotracheal intubation in children with severe exacerbations, with impending respiratory failure. Endotracheal intubation and invasive mechanical ventilation in these patients is associated with important morbidity such as barotrauma, hemodynamic instability, infections and an increased length of stay.…”

Section: Discussionmentioning

confidence: 99%

Treatment, outcomes and costs of asthma exacerbations in Chilean children: a prospective multicenter observational study

Herrera

Brand

Cavada

et al. 2019

Allergologia et Immunopathologia

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“…The main clinical findings are wheezing, shortness of breath, chest tightness and cough with variable expiratory airflow limitation. Regular controller therapy is required to achieve symptom control and avoid respiratory morbidity such as exacerbations ( 18 , 19 ).…”

Section: Asthmamentioning

confidence: 99%

“…Based on this physiologic rationale, there are several studies on the NIV use for children with acute asthma exacerbations. A recent Cochrane review included the following two studies on the use of NIV in children with acute asthma exacerbation ( 19 ). Thill et al studied the effect of NIV among 20 children with acute asthma exacerbation who were admitted to the pediatric intensive care unit (ICU) in a prospective cross-over study.…”

Section: Asthmamentioning

confidence: 99%

Non-invasive Ventilation for Children With Chronic Lung Disease

2020

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Advances in medical care and supportive care options have contributed to the survival of children with complex disorders, including children with chronic lung disease. By delivering a positive pressure or a volume during the patient's inspiration, NIV is able to reverse nocturnal alveolar hypoventilation in patients who experience hypoventilation during sleep, such as patients with chronic lung disease. Bronchopulmonary dysplasia (BPD) is a common complication of prematurity, and despite significant advances in neonatal care over recent decades its incidence has not diminished. Most affected infants have mild disease and require a short period of oxygen supplementation or respiratory support. However, severely affected infants can become dependent on positive pressure support for a prolonged period. In case of established severe BPD, respiratory support with non-invasive or invasive positive pressure ventilation is required. Patients with cystic fibrosis (CF) and advanced lung disease develop hypoxaemia and hypercapnia during sleep and hypoventilation during sleep usually predates daytime hypercapnia. Hypoxaemia and hypercapnia indicates poor prognosis and prompts referral for lung transplantation. The prevention of respiratory failure during sleep in CF may prolong survival. Long-term oxygen therapy has not been shown to improve survival in people with CF. A Cochrane review on the use NIV in CF concluded that NIV in combination with oxygen therapy improves gas exchange during sleep to a greater extent than oxygen therapy alone in people with moderate to severe CF lung disease. Uncontrolled, non-randomized studies suggest survival benefit with NIV in addition to being an effective bridge to transplantation. Complications of NIV relate mainly to prolonged use of a face or nasal mask which can lead to skin trauma, and neurodevelopmental delay by acting as a physical barrier to social interaction. Another associated risk is pulmonary aspiration caused by vomiting whilst wearing a face mask. Adherence to NIV is one of the major barriers to treatment in children. This article will review the current evidence for indications, adverse effects and long term follow up including adherence to NIV in children with chronic lung disease.

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Non-invasive positive pressure ventilation for acute asthma in children

Abstract: Current evidence does not permit confirmation or rejection of the effects of NPPV for acute asthma in children. Large RCTs with low risk of bias are warranted.

Cited by 30 publications

References 90 publications

Implementation of a Critical Care Asthma Pathway in the PICU

Implementation of a Critical Care Asthma Pathway in the PICU

Treatment, outcomes and costs of asthma exacerbations in Chilean children: a prospective multicenter observational study

Non-invasive Ventilation for Children With Chronic Lung Disease

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