511 Non Invasive Ventilation in Pediatric Status Asthmaticus: A Prospective Observational Study

Objective: Non invasive ventilation (NIV) has been shown to be effective in different causes of respiratory failure in both adult and pediatric patients. However, its role in status asthmaticus (SA) remains unclear. We designed a prospective study to assess the response of children with SA to NIV. Patients and Methods: We conducted a prospective, observational, single-center study in a teaching hospital. Children with SA unresponsive to conventional therapy with a modified Wood's clinical asthma score (m-WCAS) ≥4 after this treatment, were included. Patients were placed on pressure support NIV in spontaneous/timed mode. During NIV therapy, salbutamol was nebulized continuously and ipratropium bromide every two hours; methylprednisolone was given at a dose of 1-2 mg/kg/6 hours. Clinical variables were measured at baseline and at 1, 6, 12, 24 and 48 hours. Results: During the study period, 122 children with SA were admitted to the PICU; 72 fulfilled inclusion criteria. Baseline mean values were as follows: m-WCAS of 5.7 points, heart rate (HR) of 166.7 beats/minute, respiratory rate (RR) of 49.5 breaths/ minute and FiO 2 of 45.3%. In the first hour m-WCAS fell 2.3±1.5 points, HR 13.5±14 beats/minute and RR 9.8±10 breaths/minute (p< 0.001). Despite NIV therapy, 5 children required intubation due to increasing respiratory distress. There was one case of barotrauma, with no other serious adverse effects associated with NIV. Conclusions: These results suggest that NIV is an effective and safe therapy in children with SA unresponsive to conventional treatment. Its effects are seen from the first hours of NIV therapy.