HWN Suggests

Pediatric BIPAP

Deployment of CPAP and BIPAP in EMS has evolved over the last decade and is arguably first line intervention for acute respiratory distress for multiple adult populations. Despite these advances, we have left children behind for no reason. Pediatric patients are well known for their ability to compensate until respiratory arrest, without a declining period, we often miss opportunities to intervene and alter patient outcomes. We have equipment; why not order smaller masks and start tomorrow? Not quite that fast, remember: “Kids are not small adults!

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Articles of Interest

A Five-Year Experience With the Use of BiPAP in a Pediatric Intensive Care Unit Population

BiPAP safely and effectively improves the respiratory status of and might decrease the need for endotracheal intubation in pediatric patients with acute respiratory insufficiency of various etiologies.

Guidelines for the use of the BiPAP machine

Compared with conventional ventilation, NIV is a relatively inexpensive and simple technique which prevents the need for conventional ventilation in some patients and improves survival.

Heigh Ho High Flow Versus CPAP in Acutely Ill Children

In acutely ill pediatric patients requiring non-invasive respiratory support, you may consider either HFNC and CPAP. Use clinical judgement in determining the most appropriate modality of non-invasive ventilation based upon the patient’s presenting condition and pathophysiology. We are looking forward to future multi-national RCTs to potentially identify sub-groups that could be benefited by either mode of therapy.

High-Flow Nasal Cannula and Noninvasive Ventilation in Pediatric Emergency Medicine

NIV, which includes CPAP and BPAP, consists of an external interface that delivers pressurized gas supplied by a pressure-targeted ventilator. There are several different interfaces that can be employed... The most important aspect of the equipment is an interface that fits the patient's face correctly. Generally, one should be able to pass a finger between the headgear and the face. Without an appropriately sized mask, air leaks around the mask can occur, which lead to patient-ventilator asynchrony that results in insufficient inspiratory flow and treatment failure.

Improving Management of Severe Asthma: BiPAP and Beyond

BiPAP is the most common noninvasive positive pressure ventilation and involves both inspiratory and expiratory pressure support: inspiratory positive airway pressure (IPAP) and expiratory positive airway pressure (EPAP), which is equivalent to positive end-expiratory pressure (PEEP). BiPAP improves respiratory distress by decreasing the workload on fatigued respiratory muscles by providing a measured, pressure-supported inspiratory tidal volume and end-expiratory pressure support.

Non-Invasive Ventilation in Pediatric Medicine

Let’s now discuss the three most common types of non-invasive ventilation: CPAP, BiPAP and High-Flow Nasal Cannula. As we learned earlier CPAP stands for continuous positive airway pressure. So CPAP as the name implies maintains a continuous supply of positive or greater than atmospheric pressure air to the patient’s airway. It can be thought of as sticking ones head out of a fast moving car with your mouth open minus all the bugs you would swallow. This positive pressure works to keep the airways open and therefore to assist in breathing, by using an air “stent”. CPAP proves the most beneficial to patients who need help keeping their lungs open.

Noninvasive Ventilation

Patient selection and proper mask/interface fit is crucial. CPAP (4-8) or HFNC of 4-8LPM to reduce work of breathing (flow rates of 2L/kg/min seem to be associated with delivered PEEP).

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

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.

Pediatric CPAP in EMS: Pediatric Respiratory Illness and Current Best Practices

When was the last time you treated a child in respiratory distress? What do you remember? Did you feel comfortable managing the case? Did you feel confident in your care plan? What resources did you have available to you? Did you feel ready to escalate your care if needed? Did the patient get any better? Are you sure? Do any of these questions even matter? Are you sure? What did you do to help the patient? What did you do to help the parents? Did you do anything to help yourself after the call?

Providing Non-Invasive Ventilation (NIV) for Pediatric Patients

Typical pressure control level = 8-12 cmH2O, Typical expiratory pressure = 7-10 cmH2O.

The FIRST-ABC Step Up Trial: HFNC vs CPAP for Liberation of Respiratory Support in Children?

Based on these results, in acutely ill children admitted to the pediatric ICU assessed to require noninvasive respiratory support, 1st line HFNC, or CPAP are both reasonable for time from randomization to liberation from respiratory support. One thing to consider in making this decision is, HFNC resulted in less use of sedation for comfort, ICU and hospital length of stay compared to CPAP.