Bilevel Positive Airway Pressure Ventilation Safe for Children With Severe Asthma

Bilevel Positive Airway Pressure (BiPAP) ventilation is safe and seemingly efficient for improving respiratory rate and oxygenation in treating children with severe asthma, according to a study published in the Journal of the Formosan Medical Association.

Additional treatment may be necessary for pediatric patients with severe acute asthma exacerbation to prevent respiratory failure, yet there is a paucity of data on clinical effect of noninvasive ventilation, specifically BiPAP, in this population. In this retrospective study, researchers reviewed records for patients with severe asthma attacks who were admitted to a pediatric intensive care unit between January 2012 and February 2017 (N=46). Patients were grouped according to whether BiPAP was used (n=25) or was not used (n=21). Researchers collected and analyzed clinical parameters (age at admission, body weight, clinical symptoms, heart rate, respiratory rate, oxygen demand, oxygen saturation, and partial pressure of carbon dioxide in serum) from medical records for all patients in the study.

The BiPAP use group had significantly higher scores on standard asthma and respiratory assessment measures. The mean duration for BiPAP use was 35±21 hours. After initiation of ventilation support, partial pressure of carbon dioxide in serum levels decreased significantly in the BiPAP group (39.42±9.31 mmHg vs 33.65±4.46 mmHg). Oxygen saturation levels improved significantly in both groups (P <.001 for the BiPAP group and P =.001 for the nonBiPAP group). The patients for whom BiPAP was used had significantly higher initial respiratory rate (before intervention) compared with patients for whom BiPAP was not used (46.88±9.75 times/min vs 33.67±5.41; P <.001). However, there was no significant difference between groups in heart rate at any time interval, indicating that BiPAP use did not result in additional agitation in pediatric patients.

This study is limited by its retrospective design. Some vital sign data may not have been accurately recorded, as expected in a busy clinical setting, especially emergency room care. Additionally, arterial line monitoring was not routinely established in this patient group, which limited the researchers’ ability to analyze serial blood sampling to investigate before and after blood-gas change in the nonBiPAP group. Asthma Severity Scores were calculated with individual bias; indication for intensive care unit admission and choice of ventilation support are based on the patient’s clinical presentation and opinions of their primary caregivers. Patients in the BiPAP group had more severe respiratory conditions with increased use of magnesium sulfate compared with the nonBiPAP group.

Researchers noted that this study is, “by far the first study to evaluate the effect of BiPAP on treating Asian pediatric patients with severe asthma in a real clinical setting.” They concluded that there was, “a significant improvement of respiratory rate in patients after BiPAP support.” They further stated that BiPAP is both a well-tolerated and noninvasive alternative for oxygen support, and is, “safe and efficient for relief of respiratory symptoms in children with severe asthma attack.”

Reference

Kang CM, Wu ET, Wang CC, Lu F, Chiang BL, Yen TA. Bilevel Positive Airway Pressure ventilation efficiently improves respiratory distress in initial hours treating children with severe asthma exacerbation [published online December 2, 2019]. J Formos Med Assoc. doi: 10.1016/j.jfma.2019.11.013