NONINVASIVE VENTILATION VIA BILEVEL POSITIVE AIRWAY PRESSURE SUPPORT IN PEDIATRIC PRACTICE

Objective: To evaluate the efficacy of bilevel positive airway pressur e support in critically ill children with underlying medical condition s. Design: Prospective, clinical study. Setting: Pediatric intensive c are unit (ICU). Patients: Thirty-four patients (6 mos to 20 yrs, mean 11.06 +/- 0.9 yrs) with impending respiratory failure were enrolled in the study. All patients required airway or oxygenation/ventilation su pport (awake or asleep) and required admission to our pediatric ICU. E ach patient served as his or her own control. Exclusion criteria were absent cough or gag reflex, multiple organ system failure, age of (6 m os, vocal cord paralysis, and noncooperation with nasal mask. Interven tions: Bilevel positive airway pressure support ventilation. Measureme nts and Main Results: Thirty-four patients with 35 episodes of respira tory insufficiency requiring airway support or oxygenation/ventilatory support were treated with bilevel positive airway pressure support ve ntilation. Dyspnea score decreased at least two deviations in all pati ents; dyspnea score decreased five deviations in 67% of patients. Rest ing heart rate decreased from 126 +/- 3.2 to 102 +/- 3.2 beats/min (p < .001), respiratory rate decreased from 39 +/- 3 to 25 +/- 1 breaths/ min (p < .004), bicarbonate concentrations decreased from 30.0 +/- 1.0 to 24.0 +/- 0.7 mmol/L (p < .01), and room air saturation increased f rom 85 +/- 2% to 97 +/- 1%. Bilevel positive airway pressure support v entilation failure was characterized by an inability to stabilize prog ression of respiratory failure and the subsequent placement of an arti ficial airway. Three patients required placement of an artificial airw ay. Conclusions: A decrease in respiratory rate, heart rate, and dyspn ea score and an improvement in oxygenation were noted in >90% of patie nts studied, resulting in only an 8% frequency of intubation. The effi cacy of bilevel positive airway pressure support ventilation in select ed groups of patients indicates the need to include this form of nonin vasive pressure support ventilation in the care offered by pediatric I CUs.