title: Paediatric ED BiPAP continuous quality improvement programme with patient analysis: 2005-2013.
abstract: In paediatric moderate-to-severe asthmatics, there is significant bronchospasm, airway obstruction, air trapping causing severe hyperinflation with more positive intraplural pressure preventing passive air movement. These effects cause an increased respiratory rate (RR), less airflow and shortened inspiratory breath time. In certain asthmatics, aerosols are ineffective due to their inadequate ventilation. Bilevel positive airway pressure (BiPAP) in acute paediatric asthmatics can be an effective treatment. BiPAP works by unloading fatigued inspiratory muscles, a direct bronchodilation effect, offsetting intrinsic PEEP and recruiting collapsed alveoli that reduces the patient's work of breathing and achieves their total lung capacity quicker. Unfortunately, paediatric emergency department (PED) BiPAP is underused and quality analysis is non-existent. A PED BiPAP Continuous Quality Improvement Program (CQIP) from 2005 to 2013 was evaluated using descriptive analytics for the primary outcomes of usage, safety, BiPAP settings, therapeutics and patient disposition.
  
  
  
  PED BiPAP CQIP descriptive analytics.
  
  
  
  Academic PED.
  
  
  
  1157 patients.
  
  
  
  A PED BiPAP CQIP from 2005 to 2013 for the usage, safety, BiPAP settings, therapeutic response parameters and patient disposition was evaluated using descriptive analytics.
  
  
  
  Safety, usage, compliance, therapeutic response parameters, BiPAP settings and patient disposition.
  
  
  
  1157 patients had excellent compliance without complications. Only 6 (0.5%) BiPAP patients were intubated. BiPAP median settings: IPAP 18 (16,20) cm H2O range 12-28; EPAP 8 cmH2O (8,8) range 6-10; inspiratory-to-expiratory time (I:E) ratio 1.75 (1.5,1.75). Pediatric Asthma Severity score and RR decreased (p<0.001) while tidal volume increased (p<0.001). Patient disposition: 325 paediatric intensive care units (PICU), 832 wards, with 52 of these PED ward patients were discharged home with only 2 hours of PED BiPAP with no returning to the PED within 72 hours.
  
  
  
  BiPAP is a safe and effective therapeutic option for paediatric patients with asthma presenting to a PED or emergency department. This BiPAP CQIP showed significant patient compliance, no complications, improved therapeutics times, very low intubations and decreased PICU admissions. CQIP analysis demonstrated that using a higher IPAP, low EPAP with longer I:E optimises the patient's BiPAP settings and showed a significant improvement in PAS, RR and tidal volume. BiPAP should be considered as an early treatment in the PED severe or non-responsive moderate asthmatics.
authors.affiliation: Division of Pediatric Emergency, Department of Pediatrics, Vanderbilt School of Medicine.|Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Arkansas School of Medicine Arkansas Children's Hospital Little Rock, Little Rock, Arkansas, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Abramo
authors.affiliation: Vanderbilt School of Medicine, Nashville, Tennessee, USA.|Pediatric Emergency Medicine Associates of Atlanta, Atlanta, Georgia, USA.
authors.forename: Abby
authors.initials: A
authors.lastname: Williams
authors.affiliation: Vanderbilt School of Medicine, Nashville, Tennessee, USA.|University of Texas Southwestern Medical Center.
authors.forename: Samaiya
authors.initials: S
authors.lastname: Mushtaq
authors.affiliation: Division of Pediatric Emergency, Department of Pediatrics, Vanderbilt School of Medicine.|University of Tennessee LeBonheur Children's Hospital Memphis Tennessee.
authors.forename: Mark
authors.initials: M
authors.lastname: Meredith
authors.affiliation: Department of Respiratory Care, Vanderbilt Medical University, Vanderbilt Children's Hospital.
authors.forename: Rawle
authors.initials: R
authors.lastname: Sepaule
authors.affiliation: Division of Pediatric Emergency, Department of Pediatrics, Vanderbilt School of Medicine.
authors.forename: Kristen
authors.initials: K
authors.lastname: Crossman
authors.affiliation: Department of Pediatrics, University of Arkansas School of Medicine.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Burney Jones
authors.affiliation: Department of Pediatric Emergency Medicine, Respiratory Care, Arkansas Children's Hospital.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Godbold
authors.affiliation: Department of Pediatrics, University of Arkansas School of Medicine.
authors.forename: Zhuopei
authors.initials: Z
authors.lastname: Hu
authors.affiliation: Department of Pediatrics, University of Arkansas School of Medicine.
authors.forename: Todd
authors.initials: T
authors.lastname: Nick
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000628:therapy*; D002648:Child; D004636:Emergency Service, Hospital; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D011175:Positive-Pressure Respiration / Q000379:methods*; D058996:Quality Improvement / Q000706:statistics & numerical data*; D016896:Treatment Outcome
keywords: BiPAP; BiPAP, Status Asthmaticus, Asthma, Pediatric Emergency Department, Continuous Quality Improvement Program (CQIP) Noninvasive Pos; Continuous Quality Improvement Program (CQIP); Noninvasive Positive Pressure Ventilation; Status Asthma