Noninvasive Positive Airway Pressure in the Pediatric Emergency Department for the Treatment of Acute Asthma Exacerbations
Status: | Completed |
---|---|
Conditions: | Asthma, Hospital |
Therapuetic Areas: | Pulmonary / Respiratory Diseases, Other |
Healthy: | No |
Age Range: | 2 - 18 |
Updated: | 4/2/2016 |
Start Date: | January 2013 |
End Date: | December 2015 |
Contact: | Abby M Williams, MD |
Email: | abby.m.williams@vanderbilt.edu |
Phone: | 615-936-3898 |
A Randomized Controlled Trial of Noninvasive Positive Airway Pressure in the Pediatric Emergency Department for the Treatment of Acute Asthma Exacerbations
Previous investigations and anecdotal experience have shown safety and utility of
Noninvasive Positive Pressure Ventilation/Bilevel Positive Airway Pressure (NIPPV/BiPAP) for
the treatment of asthma in children. If NIPPV/BiPAP can be shown to have a beneficial effect
in children with respiratory insufficiency, emergency department and ICU stays may be
shortened, and the need for more invasive and dangerous airway procedures may be decreased.
This would result in a change in the standard of care for asthma treatment in emergency
departments. The investigators hypothesis is that the use of this new NIPPV, in conjunction
with current standard of care therapies, in acute moderate to severe asthma exacerbations
will lead to a more rapid improvement in patient ventilation, faster resolution of
respiratory distress, and overall improved secondary outcomes.
Noninvasive Positive Pressure Ventilation/Bilevel Positive Airway Pressure (NIPPV/BiPAP) for
the treatment of asthma in children. If NIPPV/BiPAP can be shown to have a beneficial effect
in children with respiratory insufficiency, emergency department and ICU stays may be
shortened, and the need for more invasive and dangerous airway procedures may be decreased.
This would result in a change in the standard of care for asthma treatment in emergency
departments. The investigators hypothesis is that the use of this new NIPPV, in conjunction
with current standard of care therapies, in acute moderate to severe asthma exacerbations
will lead to a more rapid improvement in patient ventilation, faster resolution of
respiratory distress, and overall improved secondary outcomes.
Inclusion Criteria:
- 2-18 years old
- For subjects 3 years and older, a known history of asthma as diagnosed by the PCP or
per the Vanderbilt problem list
- For children ages 2-3 years, four or more episodes of wheezing in the past year that
lasted more than 1 day and affected sleep AND one of the following: parental history
of asthma, a physician diagnosis of atopic dermatitis, or evidence of sensitization
to aeroallergens
- Acute asthma exacerbation
- Pediatric Asthma Score (PAS) ≥ 8
- Parents willing and able to sign consent
- Children over the age of 6 willing to provide assent
Exclusion Criteria:
- History of congenital heart disease, chronic respiratory disease including
bronchopulmonary dysplasia, cystic fibrosis, pulmonary hypertension or any chronic
lung disease other than asthma
- History of sickle cell disease
- Recently diagnosed pneumonia
- Current tracheostomy, on home ventilator or home oxygen requirement
- Recent diabetic ketoacidosis
- Requiring immediate intubation
- Weight less than 5 kilograms
- Any contraindication to BiPAP use including altered mental status, recent bowel
surgery, intractable vomiting, inability to protect airway
- A history of prematurity of ≤ 30 weeks gestation
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