This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Joshi, G. Articles by Tobias, J. D. Search for Related Content PubMed PubMed Citation Articles by Joshi, G. Articles by Tobias, J. D. Social Bookmarking                   What's this?

A Five-Year Experience With the Use of BiPAP in a Pediatric Intensive Care Unit Population

University of Missouri School of Medicine; Columbia, MO

Joseph D. Tobias, MD

Department of Anesthesiology; University of Missouri, Columbia, MO; Department of Pediatrics, University of Missouri, Columbia, MO; Department of Anesthesiology, 3W40H, University of Missouri, One Hospital Drive, Columbia, MO 65212; tobiasj{at}health.missouri.edu

The authors retrospectively reviewed their experience with bilevel positive airway pressure (BiPAP) to treat respiratory insufficiency in pediatric patients over a 5-year period. After excluding patients on chronic home BiPAP and those in whom BiPAP was used to facilitate tracheal extubation (because there were no pre-BiPAP values on which to judge its efficacy), the study cohort included 45 patients (1.5 to 22 years) in whom BiPAP was used for acute respiratory insufficiency. The primary indication for BiPAP was a primary pulmonary parenchymal process in 29 patients and postoperative atelectasis with respiratory insufficiency following cardiac or upper abdominal surgery in 16 patients. There were no differences in the pre-BiPAP values of oxygen requirement, P_CO2, oxygen saturation, and respiratory rate between the 2 groups. With the application of BiPAP in patients with primary pulmonary parenchymal disease, there was a decreased oxygen requirement, P_CO2, and respiratory rate. No change in oxygen saturation was noted. In patients with postoperative respiratory insufficiency, there was an improvement in all 4 parameters. There was no difference in post-BiPAP values of oxygen requirement, respiratory rate, or P_CO2 between the 2 groups. The post-BiPAP oxygen saturation was greater in patients with postoperative respiratory insufficiency (96% ± 4%) than in patients with primary pulmonary parenchymal disease (92% ± 6%,P = .02). Endotracheal intubation was required in 11 of 29 patients with primary pulmonary parenchymal pathology versus 1 of 16 patients with postoperative atelectasis and/or respiratory insufficiency (P = .03). The chances of requiring intubation were greater in patients 6 years of age (relative risk 1.9), if the oxygen requirement did not decrease to less than 60% within the first 24 hours of BiPAP use (relative risk 3.3) and if there were any P_CO2 values 55 mmHg during the first 24 hours of BiPAP use (relative risk 9.8). No severe complications to BiPAP were noted. BiPAP safely and effectively improves the respiratory status of and might decrease the need for endotracheal intubation in pediatric patients with acute respiratory insufficiency of various etiologies.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?