title: Non-invasive ventilation in pediatric status asthmaticus: a prospective observational study.
abstract: OBJECTIVE
  Non-invasive ventilation (NIV) has been shown to be effective in different causes of respiratory failure in both adult and pediatric patients. However, its role in status asthmaticus (SA) remains unclear. We designed a prospective study to assess the feasibility of NIV in children with SA.
  
  
  METHODS
  Prospective observational study, over a 4.5-year period.
  
  
  METHODS
  Children with SA unresponsive to conventional therapy with a modified Wood's clinical asthma score (m-WCAS) ≥4 and marked increased work of breathing, were included.
  
  
  METHODS
  Patients were placed on pressure support NIV. During NIV therapy, salbutamol was nebulized continuously and ipratropium bromide every 2 hr; methyl-prednisolone was given at a dose of 1-2 mg/kg/6 hr. Clinical variables were measured at baseline and at 1, 6, 12, 24, and 48 hr.
  
  
  RESULTS
  During the study period, there were 122 PICU admissions due to SA; 72 episodes fulfilled inclusion criteria. Baseline mean values were as follows: m-WCAS of 5.7 points, heart rate (HR) of 166.7 beats/min, respiratory rate (RR) of 49.5 breaths/min and FiO(2) of 45.3%. In the first hour m-WCAS fell 2.3 ± 1.5 points, HR 13.5 ± 14 beats/min, and RR 9.8 ± 10 breaths/min (P < 0.01). After institution of NIV therapy, 5 children required intubation due to increasing respiratory distress. There was one case of massive subcutaneous emphysema, with no other serious adverse effects associated with NIV.
  
  
  CONCLUSIONS
  These results show that NIV is a feasible therapy in children with SA unresponsive to conventional treatment. Pediatr. Pulmonol. 2011; 46:949-955. © 2011 Wiley-Liss, Inc.
authors.affiliation: Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Asturias, Spain. jmcolunga@hotmail.com
authors.forename: Juan
authors.initials: J
authors.lastname: Mayordomo-Colunga
authors.forename: Alberto
authors.initials: A
authors.lastname: Medina
authors.forename: Corsino
authors.initials: C
authors.lastname: Rey
authors.forename: Andrés
authors.initials: A
authors.lastname: Concha
authors.forename: Sergio
authors.initials: S
authors.lastname: Menéndez
authors.forename: Marta Los
authors.initials: ML
authors.lastname: Arcos
authors.forename: Ana
authors.initials: A
authors.lastname: Vivanco-Allende
mesh_terms: D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011175:Positive-Pressure Respiration; D011446:Prospective Studies; D013224:Status Asthmaticus / Q000628:therapy*