title: Noninvasive ventilation via bilevel positive airway pressure support in pediatric practice.
abstract: OBJECTIVE
  To evaluate the efficacy of bilevel positive airway pressure support in critically ill children with underlying medical conditions.
  
  
  METHODS
  Prospective, clinical study.
  
  
  METHODS
  Pediatric intensive care unit (ICU).
  
  
  METHODS
  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 support (awake or asleep) and required admission to our pediatric ICU. Each patient served as his or her own control. Exclusion criteria were absent cough or gag reflex, multiple organ system failure, age of <6 mos, vocal cord paralysis, and noncooperation with nasal mask.
  
  
  METHODS
  Bilevel positive airway pressure support ventilation.
  
  
  RESULTS
  Thirty-four patients with 35 episodes of respiratory insufficiency requiring airway support or oxygenation/ventilatory support were treated with bilevel positive airway pressure support ventilation. Dyspnea score decreased at least two deviations in all patients; dyspnea score decreased five deviations in 67% of patients. Resting 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 from 85 +/- 2% to 97 +/- 1%. Bilevel positive airway pressure support ventilation failure was characterized by an inability to stabilize progression of respiratory failure and the subsequent placement of an artificial airway. Three patients required placement of an artificial airway.
  
  
  CONCLUSIONS
  A decrease in respiratory rate, heart rate, and dyspnea score and an improvement in oxygenation were noted in >90% of patients studied, resulting in only an 8% frequency of intubation. The efficacy of bilevel positive airway pressure support ventilation in selected groups of patients indicates the need to include this form of noninvasive pressure support ventilation in the care offered by pediatric ICUs.
authors.affiliation: Department of Pediatrics, duPont Hospital for Children, Wilmington, DE 19899, USA.
authors.forename: R
authors.initials: R
authors.lastname: Padman
authors.forename: S T
authors.initials: ST
authors.lastname: Lawless
authors.forename: R G
authors.initials: RG
authors.lastname: Kettrick
mesh_terms: D000142:Acidosis, Respiratory / Q000097:blood / Q000209:etiology; D000293:Adolescent; D000328:Adult; D001639:Bicarbonates / Q000097:blood; D002648:Child; D002675:Child, Preschool; D004417:Dyspnea / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D011175:Positive-Pressure Respiration / Q000379:methods*; D011446:Prospective Studies; D012119:Respiration; D012131:Respiratory Insufficiency / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D001639:Bicarbonates