MANAGEMENT OF PEDIATRIC ACUTE HYPOXEMIC RESPIRATORY INSUFFICIENCY WITH BILEVEL POSITIVE PRESSURE (BIPAP) NASAL MASK VENTILATION

Objectives: To evaluate the efficacy and complications of noninvasive nasal mask bilevel continuous positive airway pressure ventilation in pediatric patients with hypoxemic respiratory insufficiency. Design: R etrospective chart review. Setting: Intensive care unit, university af filiated tertiary care children's hospital. Patients and methods: The study reviewed all patients admitted to the pediatric ICU with acute h ypoxemic respiratory insufficiency who received bilevel noninvasive co ntinuous nasal mask positive airway pressure delivered by a bilevel po sitive airway pressure system (BiPAP; Respironics Inc; Murrysville, Pa ). Results: Bilevel nasal mask positive pressure ventilation was utili zed in 28 patients, Median patient age was 8 years (range, 4 to 204 mo nths), The most common primary diagnosis was pneumonia, Nine patients demonstrated severe underlying neurologic disease or immunocompromise, Median duration of nasal mask ventilation was 72 h (range, 20 to 840 h). Clinical and laboratory variables immediately prior to bilevel nas al mask positive airway pressure and approximately 1 h after instituti on were evaluated, Respiratory rate decreased significantly with nasal mask ventilation (45+/-18 breaths per minute to 33+/-11, mean +/- SD, p<0.001). Arterial blood gas PaO2 (71+/-13 mm Hg to 115+/-55), PaCO2, pulse oximetry saturation, and pH all improved significantly (p<0.01) . Using standard estimates for inspired oxygen, calculated alveolar-ar terial gradients (271+/-157 to 117+/-65, p=0.001), and PaO2/FIO2 ratio s (141+/-54 to 280+/-146, p<0.001), both improved significantly with n asal mask ventilation, Only 3 of 28 patients required intubation or re intubation. Conclusions: We conclude that noninvasive nasal positive p ressure mask ventilation can be safely and effectively used in pediatr ic patients to improve oxygenation in mild to moderate hypoxemic respi ratory insufficiency. It may be particularly useful in patients whose underlying condition warrants avoidance of intubation.