title: Safety, efficacy, and tolerability of early initiation of noninvasive positive pressure ventilation in pediatric patients admitted with status asthmaticus: a pilot study.
abstract: OBJECTIVE
  Although noninvasive positive pressure ventilation is increasingly used for respiratory distress, there is not much data supporting its use in children with status asthmaticus. The objective of this study was to determine safety, tolerability, and efficacy of early initiation of noninvasive positive pressure ventilation in addition to standard of care in the management of children admitted with status asthmaticus.
  
  
  METHODS
  A prospective, randomized, controlled, clinical trial.
  
  
  METHODS
  Twenty patients (1-18 yrs old) admitted to the pediatric intensive care unit with status asthmaticus.
  
  
  RESULTS
  Children were randomized to receive either noninvasive positive pressure ventilation plus standard of care (noninvasive positive pressure ventilation group) or standard of care alone (standard group). Improvement in clinical asthma score was significantly greater in noninvasive positive pressure ventilation group compared to standard group at 2 hrs, 4-8 hrs, 12-16 hrs, and 24 hrs after initiation of interventions (p < .01). A significant decrease in respiratory rate at ≥ 24 hrs oxygen requirement after 2 hrs was noted in noninvasive positive pressure ventilation group as compared to standard group (p = .01 and p = .03, respectively). Although statistically not significant, fewer children in the noninvasive positive pressure ventilation group required adjunct therapy compared to standard group (11% vs. 50%; p = .07). There were no major adverse events related to noninvasive positive pressure ventilation. Nine out of ten patients tolerated noninvasive positive pressure ventilation through the duration of the study; noninvasive positive pressure ventilation had to be discontinued in one patient because of persistent cough.
  
  
  CONCLUSIONS
  Early initiation of noninvasive positive pressure ventilation, along with short acting β-agonists and systemic steroids, can be safe, well-tolerated, and effective in the management of children with status asthmaticus.
authors: Department of Pediatrics, Southern Illinois University School of Medicine, Springfield, IL, USA. sbasnet@siumed.edu
authors: Sangita
authors: S
authors: Basnet
authors: Gurpreet
authors: G
authors: Mander
authors: Jennifer
authors: J
authors: Andoh
authors: Helen
authors: H
authors: Klaska
authors: Steven
authors: S
authors: Verhulst
authors: Janak
authors: J
authors: Koirala
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010865:Pilot Projects; D011175:Positive-Pressure Respiration / Q000009:adverse effects; D011446:Prospective Studies; D013224:Status Asthmaticus / Q000628:therapy*; D016896:Treatment Outcome