Barotrauma not related to type of positive pressure ventilation during severe asthma exacerbations in children.
BACKGROUND
Children with impending respiratory failure due to severe asthma may be treated with endotracheal intubation and mechanical ventilation. Barotrauma occurs in a significant number of these children. Non-invasive positive pressure ventilation (NPPV) has been used as an alternative intermediary therapy and potentially prevents intubation. However, the comparative risk of barotrauma associated with the use of NPPV has not been evaluated in this population.


OBJECTIVE
To determine if the mode of positive pressure delivery per se affects the likelihood of development of barotrauma.


METHODS
We retrospectively examined data from all children older than 2 years of age admitted to the Intensive Care Unit (ICU) with an asthma exacerbation between April 1997 and August 2006.


RESULTS
Of the 293 children admitted to the ICU with asthma, 45 (17%) received treatment with positive pressure ventilation: 11 received only NPPV, 29 were intubated and mechanically ventilated, and 7 children received both of these therapies. Compared with those not requiring positive pressure, children receiving positive pressure were significantly more likely to develop barotrauma during hospitalization (OR 8.9; 95% CI 2.4-32.7). However, the incidence of barotrauma did not significantly differ according to the mode of positive pressure delivery: 9% in those who received only NPPV, 14% in those who were intubated, and 14% in those who received both therapies (p = 0.92).


CONCLUSIONS
The use of positive pressure is associated with an increased risk of barotrauma in children with asthma, regardless of the mode of delivery.
Department of Pediatrics, Connecticut Children's Medical Center, Hartford, Connecticut, USA.
Christopher L
CL
Carroll
Aaron R
AR
Zucker
D001249:Asthma / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D001469:Barotrauma / Q000453:epidemiology / Q000209:etiology*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units; D007385:Intermittent Positive-Pressure Ventilation / Q000009:adverse effects / Q000379:methods; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods; D008297:Male; D011175:Positive-Pressure Respiration / Q000009:adverse effects / Q000379:methods*; D011336:Probability; D012131:Respiratory Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013224:Status Asthmaticus / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome