Noninvasive Positive Pressure Ventilation Is Effective for Status Asthmaticus in Children

Peggy Peck

October 27, 2004

Oct. 27, 2004 (Seattle) — Results of a small series of status asthmaticus patients suggest that children who are nonresponsive to medical therapy may benefit from a trial of noninvasive positive pressure ventilation (NIPPV), according to Christopher Carroll, MD, a pediatric intensivist at Connecticut Children's Medical Center in Hartford.

Dr. Carroll, who presented his results here at CHEST 2004, the 70th annual meeting of the American College of Chest Physicians, told Medscape that based on the early results of the NIPPV review, "we are now attempting a trial of NIPPV before intubation in any nonresponsive child."

The retrospective review analyzed data from 79 status asthmaticus admissions to the intensive care unit (ICU) from October 2002 through April 2004. The mean age of the NIPPV children was 10 years (range, 3-14 years). Of the 79 admissions, five children were treated with NIPPV and eight were intubated.

"The NIPPV children were more likely to be obese," said Dr. Carroll. Four (80%) of five NIPPV patients were obese, while 38% of the intubated patients were obese and 18% of the medically treated patients were obese.

At baseline, the Modified Pulmonary Index Score (MPIS) of the NIPPV patients was 13.4, and within 60 minutes of initiation of NIPPV it was 11.4, which was statistically significant ( P = .03). MPIS scores range from 0 to 18, Dr. Carroll explained. "In general, a score of 12 to 18 is typical in an ICU patient, [and] a score of 6 is all right for outpatient management."

The patients were on continuous NIPPV with 15-minute breaks every two hours. The procedure was well tolerated, with one patient requiring sedation "and it wasn't the three-year-old patient," Dr. Carroll said. The patients were maintained on NIPPV for a mean of 33 hours, and all patients also received continuous albuterol throughout NIPPV.

The NIPPV patients spent an average of 109 hours in the ICU, while intubated patients averaged 209 hours in the ICU. The remaining patients spent an average of 55 hours in the ICU.

Harlan S. Patterson, MD, a pediatric pulmonologist at Walter Reed Army Medical Center in Washington, D.C., told Medscape that the use of NIPPV in children "is a fascinating concept. We plan to start a trial of this at our place." Dr. Patterson, who chaired the abstract session at which Dr. Carroll presented his paper, said that he learned about NIPPV from a resident who had been trained in the procedure before arriving at Walter Reed.

"This is a new way of thinking about asthma," Dr. Patterson said. "But, when you think about it, it does make sense. The decreased lung volume in these kids makes breathing more difficult, so if you increase the lung volume you decrease the work of breathing." He noted that "blowing out the lungs this way makes some pulmonologists nervous, but this is something that is done in ICU when we force the expansion so that we can get in to ventilate."

CHEST 2004: Abstract 761S. Presented Oct. 26, 2004.

Reviewed by Gary D. Vogin, MD

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