Safety, efficacy, and tolerability of early initiation of noninvasive positive pressure ventilation in pediatric patients admitted with status asthmaticus

Basnet, Sangita; Mander, Gurpreet; Andoh, Jennifer; Klaska, Helen; Verhulst, Steven J.; Koirala, Janak

doi:10.1097/pcc.0b013e318238b07a

Cited by 93 publications

(61 citation statements)

References 23 publications

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“…Clinical improvement observed with NHF in the present study was similar to that previously reported with NIV in children [7], and no patient was intubated. However, although the use of NIV for status asthmaticus in children [6, 7, 9, 44, 45] is common, the level of evidence remains limited [10]. Furthermore, in adults, the Cochrane review published in 2012 found that NIV did not provide additional benefit to medical treatment [46].…”

Section: Discussionmentioning

confidence: 99%

“…Supplemental oxygen is commonly administered to children with an asthma exacerbation in the emergency department or intensive care unit in association with beta 2 agonist nebulization [3–5]. Non-invasive ventilation (NIV) may be used as respiratory support in children with status asthmaticus in case of standard treatment failure [6–9]. However, the level of evidence of its efficacy remains low according to the grade system of evidence quality [10].…”

Section: Introductionmentioning

confidence: 99%

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Nasal high flow in management of children with status asthmaticus: a retrospective observational study

Baudin

Buisson

Vanel

et al. 2017

Ann. Intensive Care

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BackgroundAsthma is the most common obstructive airway disease in children and adults. Nasal high flow (NHF) is a recent device that is now used as a primary support for respiratory distress. Several studies have reported use of NHF as a respiratory support in status asthmaticus; however, there are no data to recommend such practice. We therefore conducted this preliminary study to evaluate NHF therapy for children with status asthmaticus admitted to our PICU in order to prepare a multicentre randomized controlled study.ResultsBetween November 2009 and January 2014, 73 patients with status asthmaticus were admitted to the PICU, of whom 39 (53%) were treated with NHF and among these 10 (26%) presented severe acidosis at admission (pH < 7.30). Thirty-four less severe children (41%) were treated with standard oxygen. For one child (2.6%) NHF failed and was then switched to non-invasive ventilation. NHF was discontinued in another patient because of the occurrence of pneumothorax after 31 h with NHF; the patient was then switched to standard oxygen therapy. Mean ± SD heart rate (165 ± 21 vs. 141 ± 25/min, p < 0.01) and respiratory rate (40 ± 13 vs. 31 ± 8/min, p < 0.01) decreased significantly, and blood gas improved in the first 24 h. In the subgroup of patients with acidosis, median [IQR] pH increased significantly between hour 0 and 2 (7.25 [7.21–7.26] vs. 7.30 [7.27–7.33], p = 0.009) and median [IQR] pCO2 decreased significantly (7.27 kPa [6.84–7.91 vs. 5.85 kPa [5.56–6.11], p = 0.007). No patient was intubated.ConclusionThis retrospective study showed the feasibility and safety of NHF in children with severe asthma. Blood gas and clinical parameters were significantly improved during the first 24 h. NHF failed in only two patients, and none required invasive ventilation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Nasal high flow in management of children with status asthmaticus: a retrospective observational study

Baudin

Buisson

Vanel

et al. 2017

Ann. Intensive Care

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“…1 NIV is associated with improved mortality in adult patients with COPD and other forms of respiratory distress. [2][3][4][5][6][7][8][9][10][11][12] One randomized controlled trial 13 and several small observational studies [14][15][16] found NIV safe and effective in supporting children with respiratory failure, including patients with asthma not responding to conventional therapies.…”

Section: Introductionmentioning

confidence: 99%

Bronchodilator Delivery During Simulated Pediatric Noninvasive Ventilation

et al. 2013

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BACKGROUND: Noninvasive ventilation (NIV) is usually applied using bi-level positive airway pressure devices, and many of these devices use a single-limb patient circuit with an integrated leak port to purge the circuit of exhaled carbon dioxide. Sometimes bronchodilator therapy is indicated in pediatric patients, but there have been no studies of the optimal nebulizer position, with respect to leak, during pediatric NIV. We hypothesized that there would be no differences in albuterol delivery with a vibrating-mesh nebulizer between 3 different positions/exhalation leak valve combinations in the patient circuit during simulated pediatric NIV. METHODS: A simulated upper airway model was attached to a lung model that simulated spontaneous breathing. A noninvasive ventilator equipped with heated wire circuit and heated humidifier was attached to the lung model via a pediatric oronasal mask. Albuterol (5 mg) was delivered with a vibrating-mesh nebulizer, at 3 different circuit position/leak condition combinations: prior to the humidifier and leak valve; between the humidifier and leak valve; and integrated within the mask and after the leak. Albuterol was captured on a filter and quantified with chromatography. RESULTS: Greater albuterol mass was delivered to the filter with the nebulizer integrated into the mask than at any other testing condition (P < .001). In the conditions where the nebulizer was placed prior to the exhalation leak valve, greater drug delivery was observed when the nebulizer was placed proximal to the mask (position 2) than when placed prior to the humidifier (position 3, P ‫؍‬ .002). CONCLUSIONS: Albuterol delivery during simulated pediatric NIV was affected by the position of the nebulizer in relation to the expiratory leak valve and the nebulizer's distance from the filter. A vibrating-mesh nebulizer placed intra-mask may provide a better alternative for medication delivery than those previously used during pediatric NIV.

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“…However, not all studies adjusted for confounding factors, and the lack of multicenter involvement prevents widespread generalizability of their findings. Findings from the few RCTs available on this topic in critically ill children do support the premise of improved outcomes for selected patients treated with NIV in preference to IV (7–10). …”

Section: Discussionmentioning

confidence: 91%

“…Randomized controlled trials (RCTs) in adults with chronic obstructive pulmonary disease and cardiogenic pulmonary edema, and in premature newborns with respiratory distress, have demonstrated that noninvasive ventilation (NIV) modalities such as continuous or bi-level positive airway pressure can reduce the need for endotracheal intubation and improve patient outcomes (2–6). However, there is a paucity of RCT evidence in critically ill children: just one clinical trial including only 50 patients, and three other small RCTs restricted to specific conditions such as bronchiolitis, asthma, and dengue shock syndrome exist (7–10). Despite this scarcity of evidence, national audit data from PICUs in the United Kingdom and Ireland have shown increasing use of NIV over the past 10 years (11), mirroring an international trend of greater adoption of NIV (12, 13).…”

mentioning

confidence: 99%

Outcomes for Children Receiving Noninvasive Ventilation as the First-Line Mode of Mechanical Ventilation at Intensive Care Admission: A Propensity Score-Matched Cohort Study*

Morris

Ramnarayan

Parslow

et al. 2017

Critical Care Medicine

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1045Objectives: To compare outcomes of children receiving noninvasive ventilation with those receiving invasive ventilation as first-line mode of mechanical ventilation following unplanned intensive care admission. Design: Propensity score-matched cohort study analyzing data prospectively collected by the Pediatric Intensive Care Audit Network over 8 years (2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014). Setting: Thirty-one PICUs in the United Kingdom and Ireland; twenty-one of whom submitted Pediatric Critical Care Minimum Dataset data for the entire study period. Patients: Children consecutively admitted to study PICUs. Planned admissions following surgery, unplanned admissions from other hospitals, those on chronic ventilation, and those who did not receive mechanical ventilation on the day of PICU admission were excluded. Interventions: Use of noninvasive ventilation, rather than invasive ventilation, as the first-line mode of mechanical ventilation. Measurements and Main Results: PICU mortality, length of ventilation, length of PICU stay, and ventilator-free days at day 28. During the study period, there were 151,128 PICU admissions. A total of 15,144 admissions (10%) were eligible for analysis once predefined

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Safety, efficacy, and tolerability of early initiation of noninvasive positive pressure ventilation in pediatric patients admitted with status asthmaticus

Abstract: Early initiation of noninvasive positive pressure ventilation, along with short acting β-agonists and systemic steroids, can be safe, well-tolerated, and effective in the management of children with status asthmaticus.

Cited by 93 publications

References 23 publications

Nasal high flow in management of children with status asthmaticus: a retrospective observational study

Nasal high flow in management of children with status asthmaticus: a retrospective observational study

Bronchodilator Delivery During Simulated Pediatric Noninvasive Ventilation

Outcomes for Children Receiving Noninvasive Ventilation as the First-Line Mode of Mechanical Ventilation at Intensive Care Admission: A Propensity Score-Matched Cohort Study*

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