Paediatric ED BiPAP continuous quality improvement programme with patient analysis: 2005–2013

Abstract

ObjectiveIn 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.InterventionsPED BiPAP CQIP descriptive analytics.SettingAcademic PED.Participants1157 patients.InterventionsA PED BiPAP CQIP from 2005 to 2013 for the usage, safety, BiPAP settings, therapeutic response parameters and patient disposition was evaluated using descriptive analytics.Primary and secondary outcomesSafety, usage, compliance, therapeutic response parameters, BiPAP settings and patient disposition.Results1157 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.ConclusionsBiPAP 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.

Impact of Oxygen Delivery Patterns on Arterial Oxygen Saturation Among Children

“…ABG analysis reports highlighted comparable acid base disturbances with 42% samples having metabolic acidosis similar to study samples by Anitha et al [16] (47%), which commonly occurs in critically ill children [17]. BiPAP and CPAP had been found as the best ventilation mode for 78% participants to treat respiratory disorders in consistency with prescription by Abramo et al [18]. NaHCO 3 supplementation remained as the mainstay in treating acid base disorders, a common clinical practice noted by Daly et al [19].…”

Bi-level Positive Airway Pressure Versus Nasal CPAP for the Prevention of Extubation Failure in Infants After Cardiac Surgery

“…BPAP provides 2 different levels of pressure support during the respiratory cycle, and patients can breathe spontaneously and completely under high pressure and low pressure, avoiding the problem of patient-ventilator asynchrony. 33,34 After 24 h of treatment, P aO 2 /F IO 2 in the BPAP group was higher than in the nasal CPAP group, whereas P aCO 2 in the BPAP group was lower than that in the nasal CPAP group. The reason may be that compared with nasal CPAP BPAP can intermittently give higher pressure Data are expressed as n (%) or mean (6 SD).…”

Bilevel Positive Airway Pressure Versus Nasal Continuous Positive Airway Pressure for Prevention of Extubation Failure in Infants After Cardiac Surgery: A Randomized Controlled Trial

“…BiPAP not only retains the characteristics of NCPAP but also combines the advantages of the pressure support/pressure control ventilation mode. BiPAP provides two different levels of pressure support during the respiratory cycle, and patients can breathe spontaneously completely under high pressure and low pressure, avoiding the problem of man-machine confrontation [28,29]. After a certain period of treatment, PaO 2 /FiO 2 in the BiPAP group was higher than that in the NCPAP group, while PaCO 2 in the BiPAP group was lower than that in the NCPAP group.…”