Early Noninvasive Positive Pressure Ventilation in Children With Status Asthmaticus
Early Noninvasive Positive Pressure Ventilation in Children With Status Asthmaticus
Status asthmaticus is recognized as a common cause of morbidity in children in the United
 States. In recent years, hospitalization rates have reached an all time high. This study will
 evaluate the safety, tolerability and clinical benefit of adding Noninvasive Positive
 Pressure Ventilation (NPPV)to regular care in children with moderate to moderately severe
 status asthmaticus.
Status asthmaticus is defined as severe asthma that fails to respond to inhaled short acting
 β agonists (SABA), oral or intravenous steroids, and oxygen, leading to hospital admission
 for further management (1). In 2004, asthma exacerbations led to 3% (198,000) of all
 hospitalizations and 2.5 deaths per 1 million populations in the 0-17 year age group (2).

 This prospective, unblinded, randomized controlled, pilot clinical trial will compare NPPV
 plus standard of care versus standard of care alone in children admitted for status
 asthmaticus. NPPV refers to the delivery of pressurized gas through an external interface
 such as a nasal or oronasal mask, connected to a pressure targeted ventilator. In other
 words, it provides ventilator support without the use of an endotracheal tube.

 This study will investigate the safety, tolerability and efficacy of early initiation of
 non-invasive NPPV in pediatric patients admitted with status asthmaticus.
Inclusion Criteria:

 -  children, 1- 18 years of age, with a known history of asthma admitted to the PICU at
 St John's Children's Hospital with status asthmaticus

 -  clinical asthma score (CAS) between 3 - 8 after receiving one dose of systemic
 steroid, 1 hour of continuous albuterol (SABA), and 3 doses of ipratropium bromide

 -  written informed consent from the patient's parent or legal guardian

 Exclusion Criteria:

 -  no previous history of asthma,

 -  absence of airway protective reflexes,

 -  absence of respiratory drive,

 -  excessive oral secretions,

 -  need for emergent intubation as determined by the attending physician,

 -  facial or airway anomaly or injury precluding the use of tight fitting mask