| Carroll and Schramm(
(1010 Carroll CL, Schramm CM. Noninvasive positive pressure ventilation for the treatment of status asthmaticus in children. Ann Allergy Asthma Immunol. 2006;96(3):454-9.)
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Retrospective, case series (review of medical records) |
5 children 2 to 18 years old with SA received NIV as a part of the treatment performed in a PICU from October 2002 to April 2004. Children with conditions other than asthma were not included. |
No intervention. Evaluation before onset of NIV and 30 and 60 minutes afterwards (RR, MPIS, oxygen saturation:. BIPAP 12 - 16 X 6 - 8. Patients were allowed 15-minute breaks every 2 hours for comfort, eating and drinking. NIV stopped based on staff assessment. Associated conventional treatment. |
4 out the 5 children were morbidly obese; significant ≠: ↓ RR (p = 0.03), clinical improvement according to MPIS (p = 0.03) after onset of NIV. Average NIV duration = 33.2 hours. NIV was well tolerated by all of the children; 1 required sedation. |
NIV was well tolerated by this group of children with SA and can improve subjective and objective measures of respiratory dysfunction. NIV may be a useful adjunct in the treatment of SA in children. |
| Mayordomo-Colunga et al.(
(44 Mayordomo-Colunga J, Medina A, Rey C, Concha A, Menéndez S, Arcos ML, et al. Non-invasive ventilation in pediatric status asthmaticus: a prospective observational study. Pediatr Pulmonol. 2011;46(10):949-55.)
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Prospective observational |
72 children over six months old with SA unresponsive to standard treatment, m-WCAS > 4 and ↑ work of breathing; PICU, July 2004 to December 2009. Children with contraindications for NIV were excluded. OTI criterion: no improvement with BIPAP settings up to 20 X 10 |
Patients evaluated 1, 6, 12, 24 and 48 hours after onset of treatment. Nasal or face mask; short periods without NIV for comfort and aspiration; initial parameters: EPAP 5 and IPAP 6 - 8cmH2O; sedation for adaptation as per need; nebulization coupled to the circuit + conventional treatment |
Significant p < 0.05; 72 children received NIV; Improvement of m-WCAS, ↓ HR and RR in the first hour (p < 0.01); PaCO2 measured before NIV in 13 cases, all showed ↓ PaCO2 in the first hour; average NIV duration 33 hours; average length of stay 3 days; face mask in 91.5% of cases; skin lesion (11), gastric distension (4), UA bleeding, barotrauma and subcutaneous emphysema (1 each); sedation in 58.3% (younger children - p < 0.01); 5 OTIs; 1 death after OTI (arrhythmia). |
The results show that NIV is a feasible therapy in children with SA unresponsive to conventional treatment. |
| Akingbola et al.(
(2222 Akingbola OA, Simakajornboon N, Hadley Jr EF, Hopkins RL. Noninvasive positive-pressure ventilation in pediatric status asthmaticus. Pediatr Crit Care Med. 2002;3(2):181-4.)
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Case report |
3 children - 9, 11 and 15 years old, hypercapnic respiratory failure by SA, PICU from 2 institutions |
No intervention. Description of cases. |
48 hours in ICU; BIPAP 12 to 17 hours; IPAP 10 to 14 and EPAP 4 to 5; BIPAP → ABGs improvement (↑ pH and ↓PaCO2), gradual ↓RR |
In 3 children with SA, BIPAP seemed to improve ventilation and gas exchange, culminating in resolution of hypercapnic respiratory failure. RCTs assessing NIV in this clinical condition are needed. |
| Beers et al.(
(2121 Beers SL, Abramo TJ, Bracken A, Wiebe RA. Bilevel positive airway pressure in the treatment of status asthmaticus in pediatrics. Am J Emerg Med. 2007;25(1):6-9.)
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Retrospective descriptive |
83 children - 2 to 17 years old with acute asthma refractory to conventional treatment treated with BIPAP; pediatric emergency department, from April 1 2003 to August 31 2004. |
No intervention. Review of medical records by the principal investigator. BIPAP by nasal mask; children with any comorbidity were excluded from the study. |
Average age 8 years old; 64% males; average BIPAP duration: 5.8 hours; 73 tolerated BIPAP - 4 did not tolerate BIPAP from the first seconds - 10 minutes; 77% ↓ RR, 23% with no change; 88% ↑ oxygen saturation, 12% with no change (adequate saturation before BIPAP); 78 admitted to PICU, 2 OTIs. 22% in ward service; no deaths, pneumothorax, pneumomediastinum or epistaxis |
The results suggest that addition of BIPAP in treating pediatric SA is safe and well tolerated. This intervention shows promise as a beneficial adjunct to conventional medical treatments. However, future prospective investigation is warranted to confirm these findings. |
| Needleman et al.(
(1919 Needleman JP, Sykes JA, Schroeder SA, Singer LP. Noninvasive positive pressure ventilation in the treatment of pediatric status asthmaticus. Pediatr Asthma Allergy Immunol. 2004;17(4):272-7.)
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Prospective trial |
18 patients 8 - 21 years old - SA refractory to conventional treatment in PICU. Did not include children < 8 years old because they tend not to tolerate the mask or children with cardiovascular diseases, pneumothorax or UA obstruction. |
BIPAP through nasal mask, initial parameters 10 X 4, ↑ as per tolerance up to 15 X 6 after 10 minutes. RIP before, during and after NIV (10 minutes at each stage: to assess respiratory mechanics. |
15 children completed the study (2 excluded for data system malfunction, 1 for discomfort under NIV even with improvement on RIP). After onset of NIV ↓ RR (p = 0.002), fractional inspired time (Ti/Ttot - p = 0.01) and rib cage-abdominal phase angle (p = 0.02) in 12 out of the 15 patients. 3 patients did not exhibit clear response to NIV |
NIV is a safe and effective treatment of SA in pediatric patients. |
| Basnet et al.(
(1717 Basnet S, Mander G, Andoh J, Klaska H, Verhulst S, Koirala J. Safety, efficacy, and tolerability of early initiation of noninvasive positive pressure ventilation in pediatric patients admitted with status asthmaticus: a pilot study. Pediatr Crit Care Med. 2012;13(4):393-8.)
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RCT, prospective, non-blinded |
20 patients; PICU; 1 - 18 years old - SA, from January 2009 to January 2010; CAS 3 to 8 after initial pharmacological treatment. Excluded patients without UA protective reflexes or respiratory drive, lesions in or procedures involving the face. No demographic differences between the groups at baseline. |
10 patients randomized to receive NIV + standard treatment (GNIV) and 10 patients standard treatment only (Gstandard); BIPAP through nasal or full-face mask, 8 X 5 for VT 6 to 9 mL/ kg; bronchodilator through the circuit as needed; evaluation at 2, 4 - 8, 12 - 16 and 24 hours after onset of intervention by respiratory therapist (not involved in the study) → CAS, RR, HR, need for oxygen and associated treatments. |
GNIV: greater improvement on CAS at all time-points of evaluation (p < 0.1), greater ↓ RR and oxygen requirement after 2 hours (p = 0.1 and p = 0.3); children had less need for adjunct therapies (statistically non-significant) and ↓ HR (at 12-16 hours, statistically significant); 9 out the 10 children tolerated NIV (in 1 NIV was discontinued due to persistent cough); all the children attained VT 6 to 9mL/kg with 8 X 5 except for 1 - required full-face mask. Length of stay at PICU similar in both groups. |
Early initiation of NIV along with short acting bronchodilators and systemic steroids can be safe, well tolerated and effective in the management of children with SA. |
| Williams et al.(
(2020 Williams AM, Abramo TJ, Shah MV, Miller RA, Burney-Jones C, Rooks S, et al. Safety and clinical findings of BiPAP utilization in children 20 kg or less for asthma exacerbations. Intensive Care Med. 2011;37(8):1338-43.)
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Descriptive, prospective and retrospective |
165 children < 20kg; moderate/severe asthma exacerbations; emergency department; age: 0.6 to 8.24 years old. Children who received BIPAP < 30 minutes, born with gestational age < 28 weeks or with chronic disorders were excluded. |
Retrospective and prospective description of 112 and 53 patients, respectively. |
No deaths, pneumothorax or aspiration pneumonia (1 case with vomiting); 4 OTI even after NIV; 6 patients excluded due to NIV < 30 minutes (agitation; children aged 1 to 4 years old). Improvement on PAS in all of the cases; 99 children were admitted to ICU, 57 to hospital wards and 9 were discharged home. |
BIPAP utilization in acute pediatric asthma exacerbations for patients < 20kg is safe and may improve clinical outcomes. These findings warrant future prospective investigation of this subject. |
| Thill et al.(
(1818 Thill PJ, McGuire JK, Baden HP, Green TP, Checchia PA. Noninvasive positive-pressure ventilation in children with lower airway obstruction. Pediatr Crit Care Med. 2004;5(4):337-42.)
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Prospective, crossover randomized |
20 children aged 2 months to 14 years old, admitted to PICU along 6 months, with lower airway obstruction and CAS > 3 - < 8; children with tracheostomy, absent airway protection reflexes, abnormalities in or procedures involving the face were excluded; no significant differences between the groups at baseline; no patient with severe hypercapnia. |
Patients randomized to receive either 2 hours of NIV followed by crossover to 2 hours of standard treatment alone (G1) or vice-versa (G2). BIPAP through nasal mask, spontaneous mode, backup RR 10, initial parameters 10 X 5, bronchodilator through circuit as per need. Patients independently assessed by principal investigator and respiratory therapist 2 and 4 hours after onset of treatment by means of CAS. |
4 patients did not complete the study: 3 OTIs (1 from G1 and 2 from G2); NIV discontinued in 1 patient due to discomfort; no deaths or adverse events; no significant difference between the principal investigator's and respiratory therapist's assessments; ↓ RR, CAS while under NIV in both groups; NIV did not change HR in either group; no significant difference in oxygen saturation or transcutaneous CO2; required FiO2 + ↓ in the patients under NIV; no child was given sedatives or anxiolytics. |
NIV can be an effective treatment for children with acute lower airway obstruction. |
| Haggenmacher et al.(
(2323 Haggenmacher C, Biarent D, Otte F, Fonteyne C, Clement S, Deckers S. [Non-invasive bi-level ventilation in paediatric status asthmaticus]. Arch Pediatr. 2005;12(12):1785-7)
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Case report |
One 11-month-old infant with SA, respiratory dysfunction, ABGs: pH 7.29 and PaCO2 69; already given oxygen and conventional treatment. |
Non-invasive BIPAP through an adult nasal mask used as a pediatric face mask; 11 X 6 initially, IPAP ↑ to 13 after RR 30. |
Improvement of respiratory dysfunction and ABGs return to normal values in 72 hours. |
NIV + standard treatment is useful for small children with SA refractory to conventional treatment; RCTs are warranted to confirm findings. |
