MANAGEMENT OF PEDIATRIC ACUTE HYPOXEMIC RESPIRATORY INSUFFICIENCY WITH BILEVEL POSITIVE PRESSURE (BIPAP) NASAL MASK VENTILATION

Objectives: To evaluate the efficacy and complications of noninvasive nasal mask bilevel continuous positive airway pressure ventilation in pediatric patients with hypoxemic respiratory insufficiency. Design: Retrospective chart review. Setting: Intensive care unit, university affiliated tertiary care children's hospital. Patients and methods: The study reviewed all patients admitted to the pediatric ICU with acute hypoxemic respiratory insufficiency who received bilevel noninvasive continuous nasal mask positive airway pressure delivered by a bilevel positive airway pressure system (BiPAP; Respironics Inc; Murrysville, Pa). Results: Bilevel nasal mask positive pressure ventilation was utilized in 28 patients, Median patient age was 8 years (range, 4 to 204 months), The most common primary diagnosis was pneumonia, Nine patients demonstrated severe underlying neurologic disease or immunocompromise, Median duration of nasal mask ventilation was 72 h (range, 20 to 840 h). Clinical and laboratory variables immediately prior to bilevel nasal mask positive airway pressure and approximately 1 h after institution were evaluated, Respiratory rate decreased significantly with nasal mask ventilation (45+/-18 breaths per minute to 33+/-11, mean +/- SD, p<0.001). Arterial blood gas PaO2 (71+/-13 mm Hg to 115+/-55), PaCO2, pulse oximetry saturation, and pH all improved significantly (p<0.01). Using standard estimates for inspired oxygen, calculated alveolar-arterial gradients (271+/-157 to 117+/-65, p=0.001), and PaO2/FIO2 ratios (141+/-54 to 280+/-146, p<0.001), both improved significantly with nasal mask ventilation, Only 3 of 28 patients required intubation or reintubation. Conclusions: We conclude that noninvasive nasal positive pressure mask ventilation can be safely and effectively used in pediatric patients to improve oxygenation in mild to moderate hypoxemic respiratory insufficiency. It may be particularly useful in patients whose underlying condition warrants avoidance of intubation.