Noninvasive ventilation in status asthmaticus in children: levels of evidence

Abstract

Objective To evaluate the quality of available evidence to establish guidelines for the use of noninvasive ventilation for the management of status asthmaticus in children unresponsive to standard treatment.Methods Search, selection and analysis of all original articles on asthma and noninvasive ventilation in children, published until September 1, 2014 in all languages in the electronic databases PubMed, Web of Science, Cochrane Library, Scopus and SciELO, located using the search terms: "asthma", "status asthmaticus", "noninvasive ventilation", "Bronchospasm", "continuous positive airway pressure", "child", "infant", "pediatrics", "hypercapnia", "respiratory failure" and the keywords "BIPAP", "CPAP", "Bilevel", "acute asthma" and "near fatal asthma". The articles were assessed based on the levels of evidence of the GRADE system.Results Only nine original articles were located; two (22%) articles had level of evidence A, one (11%) had level of evidence B and six (67%) had level of evidence C.Conclusion The results suggest that noninvasive ventilation is applicable for the treatment of status asthmaticus in most pediatric patients unresponsive to standard treatment. However, the available evidence cannot be considered as conclusive, as further high-quality research is likely to have an impact on and change the estimate of the effect.

Nasal high flow in management of children with status asthmaticus: a retrospective observational study

“…Clinical improvement observed with NHF in the present study was similar to that previously reported with NIV in children [ 7 ], and no patient was intubated. However, although the use of NIV for status asthmaticus in children [ 6 , 7 , 9 , 44 , 45 ] is common, the level of evidence remains limited [ 10 ]. Furthermore, in adults, the Cochrane review published in 2012 found that NIV did not provide additional benefit to medical treatment [ 46 ].…”

“…Non-invasive ventilation (NIV) may be used as respiratory support in children with status asthmaticus in case of standard treatment failure [ 6 – 9 ]. However, the level of evidence of its efficacy remains low according to the grade system of evidence quality [ 10 ].…”

Management of asthma exacerbation in the emergency departments

“…Therefore, its use has become frequent. The main mechanism involves stenting the airway combined with the a bronchodilator, which induces alveolar recruitment [[85], [86], [87], [88], [89], [90]].…”

Noninvasive positive pressure ventilation for treating acute asthmatic attacks in three pregnant women with dyspnea and hypoxemia

“…We present three cases of pregnant women in whom symptoms of severe dyspnea and hypoxemia due to acute asthma exacerbation were alleviated following NPPV in addition to standard therapy. Although NPPV is a ventilatory support that is being increasingly used during acute asthma attacks, a definitive consensus is lacking in guidelines . This is because, regarding the results of several previous reports, NPPV for asthma attacks are observational research and cohort research subjects, and only a small number of randomized controlled trials (RCTs) are on the scale of 10‐20 patients .…”

“…When an asthma attack occurs in the primary‐care setting, the patient must be transferred to an acute‐care facility to undergo controlled oxygen therapy, inhalation therapy with short‐acting beta‐2 agonists and ipratropium bromide, and systemic corticosteroid thepary . In patients who do not respond well to oxygen therapy alone, noninvasive positive pressure ventilation (NPPV) has been effectively used to treat hypoxemia and hypercapnia associated with asthma attacks . Although few reports have described the use of NPPV for acute asthma exacerbations in pregnant women, this approach could be beneficial for these patients.…”