Virginia A. Schad, PharmD, RPh
Noninvasive ventilation (NIV) is commonly used in the management of pediatric status asthmaticus and is often initiated in the emergency department (ED), according to a study published in the Journal of Asthma.
While NIV is sometimes used in refractory pediatric status asthmaticus for its potential benefits of stenting airways and dispersing albuterol, the study authors wrote, its effectiveness in pediatric asthma remains unproven. Therefore the researchers, from the New York-Presbyterian Morgan Stanley Children’s Hospital and Columbia University Irving Medical Center in New York City, sought to describe the usage pattern of NIV and report the outcomes and safety in pediatric patients with status asthmaticus.
A total of 101 unique admissions were identified. The patients’ mean age was 7 years. The investigators reported previously diagnosed asthma in 63% of patients and prior PICU admissions in 27%.
They determined that 54% of patients received NIV in the form of bilevel positive airway pressure (BPAP) or continuous positive airway pressure (CPAP), with 20 cases (37%) commencing in the ED. Oxygen saturation at presentation was significantly lower in the NIV vs the non-NIV group (P <.05). Rhinovirus/enterovirus was identified in 82% of the cohort, however, no pneumothoraces, pneumomediastinum, or aspiration pneumonias were documented on available chest radiographs (n=83).
The study authors concluded, “NIV was frequently used, well tolerated, safe, and few patients progressed to mechanical ventilation.” They emphasized that “[f]uture prospective, randomized control trials are urgently needed to determine if NIV affects duration of continuous albuterol, PICU admissions, symptom improvement, and length of stay in moderate to severe pediatric asthma exacerbations.”
Reference
Usala C, Wilson P. Noninvasive ventilation use in pediatric status asthmaticus. J Asthma. Published online June 18, 2021. doi:10.1080/02770903.2021.1941085