Pediatric BiPaP
What is BIPAP?
One of the most utilized forms of non-invasive ventilation utilized in pediatric care is:
BiPAP: Bi-level Positive Airway Pressure.
Non-invasive positive pressure ventilator support is a technology utilized to augment
alveolar ventilation for prescribed periods without an artificial airway.
Why would a pediatric patient need BIPAP?
Different pediatric patients require the use of BIPAP for different reasons, some of the
most common indications are:
Airway obstruction
Increased work of breathing due to pulmonary congestion
Muscle weakness leading to inadequate respirations
Restrictive lung disease leading to poor lung expansion
Poor lung compliance leading to poor lung expansion
Obesity and cardiac failure
Some contraindications for BIPAP include patients who have:
Pneumothorax
DO NOT have a respiratory drive to breath
Upper gastrointestinal bleeding
Recent gastric or esophageal surgery
Tracheostomy or other airway disorders
BIPAP is commonly used in pediatric patients who require non-invasive ventilation
In pediatric moderate-to-severe asthmatics, there is significant bronchospasm, airway obstruction, air trapping causing severe hyperinflation with more positive intraplural pressure preventing passive air movement. These effects cause an increased respiratory rate (RR), less airflow and shortened inspiratory breath time. In certain asthmatics, aerosols are ineffective due to their inadequate ventilation. Bilevel positive airway pressure (BiPAP) in acute pediatric asthmatics can be an effective treatment. BiPAP works by unloading fatigued inspiratory muscles, a direct bronchodilation effect, offsetting intrinsic PEEP and recruiting collapsed alveoli that reduces the patient’s work of breathing and achieves their total lung capacity quicker. Unfortunately, pediatric emergency department (PED) BiPAP is underused and quality analysis is non-existent. A PED BiPAP Continuous Quality Improvement Program (CQIP) from 2005 to 2013 was evaluated using descriptive analytics for the primary outcomes of usage, safety, BiPAP settings, therapeutics and patient disposition.
Interventions
PED BiPAP CQIP descriptive analytics.
Setting
Academic PED.
Participants
1157 patients.
Interventions
A PED BiPAP CQIP from 2005 to 2013 for the usage, safety, BiPAP settings, therapeutic response parameters and patient disposition was evaluated using descriptive analytics.
Primary and secondary outcomes
Safety, usage, compliance, therapeutic response parameters, BiPAP settings and patient disposition.
Results
1157 patients had excellent compliance without complications. Only 6 (0.5%) BiPAP patients were intubated. BiPAP median settings: IPAP 18 (16,20) cm H2O range 12–28; EPAP 8 cmH2O (8,8) range 6–10; inspiratory-to-expiratory time (I:E) ratio 1.75 (1.5,1.75). Pediatric Asthma Severity score and RR decreased (p<0.001) while tidal volume increased (p<0.001). Patient disposition: 325 pediatric intensive care units (PICU), 832 wards, with 52 of these PED ward patients were discharged home with only 2 hours of PED BiPAP with no returning to the PED within 72 hours.
Conclusions
BiPAP is a safe and effective therapeutic option for pediatric patients with asthma presenting to a PED or emergency department. This BiPAP CQIP showed significant patient compliance, no complications, improved therapeutics times, very low intubations and decreased PICU admissions. CQIP analysis demonstrated that using a higher IPAP, low EPAP with longer I:E optimizes the patient’s BiPAP settings and showed a significant improvement in PAS, RR and tidal volume. BiPAP should be considered as an early treatment in the PED severe or non-responsive moderate asthmatics. Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5253518/
