Paediatric ED BiPAP continuous quality improvement programme with patient analysis: 2005-2013.
| Autor: | Abramo T; Division of Pediatric Emergency, Department of Pediatrics, Vanderbilt School of Medicine.; Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Arkansas School of Medicine Arkansas Children's Hospital Little Rock, Little Rock, Arkansas, USA., Williams A; Vanderbilt School of Medicine, Nashville, Tennessee, USA.; Pediatric Emergency Medicine Associates of Atlanta, Atlanta, Georgia, USA., Mushtaq S; Vanderbilt School of Medicine, Nashville, Tennessee, USA.; University of Texas Southwestern Medical Center., Meredith M; Division of Pediatric Emergency, Department of Pediatrics, Vanderbilt School of Medicine.; University of Tennessee LeBonheur Children's Hospital Memphis Tennessee., Sepaule R; Department of Respiratory Care, Vanderbilt Medical University, Vanderbilt Children's Hospital., Crossman K; Division of Pediatric Emergency, Department of Pediatrics, Vanderbilt School of Medicine., Burney Jones C; Department of Pediatrics, University of Arkansas School of Medicine., Godbold S; Department of Pediatric Emergency Medicine, Respiratory Care, Arkansas Children's Hospital., Hu Z; Department of Pediatrics, University of Arkansas School of Medicine., Nick T; Department of Pediatrics, University of Arkansas School of Medicine. |
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| Jazyk: | angličtina |
| Zdroj: | BMJ open [BMJ Open] 2017 Jan 16; Vol. 7 (1), pp. e011845. Date of Electronic Publication: 2017 Jan 16. |
| DOI: | 10.1136/bmjopen-2016-011845 |
| Abstrakt: | Objective: In paediatric moderate-to-severe asthmatics, there is significant bronchospasm, airway obstruction, air trapping causing severe hyperinflation with more positive intraplural pressure preventing passive air movement. These effects cause an increased respiratory rate (RR), less airflow and shortened inspiratory breath time. In certain asthmatics, aerosols are ineffective due to their inadequate ventilation. 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. A PED BiPAP Continuous Quality Improvement Program (CQIP) from 2005 to 2013 was evaluated using descriptive analytics for the primary outcomes of usage, safety, BiPAP settings, therapeutics and patient disposition. Interventions: PED BiPAP CQIP descriptive analytics. Setting: Academic PED. Participants: 1157 patients. Interventions: A PED BiPAP CQIP from 2005 to 2013 for the usage, safety, BiPAP settings, therapeutic response parameters and patient disposition was evaluated using descriptive analytics. Primary and Secondary Outcomes: Safety, usage, compliance, therapeutic response parameters, BiPAP settings and patient disposition. Results: 1157 patients had excellent compliance without complications. Only 6 (0.5%) BiPAP patients were intubated. BiPAP median settings: IPAP 18 (16,20) cm H Conclusions: BiPAP is a safe and effective therapeutic option for paediatric patients with asthma presenting to a PED or emergency department. This BiPAP CQIP showed significant patient compliance, no complications, improved therapeutics times, very low intubations and decreased PICU admissions. CQIP analysis demonstrated that using a higher IPAP, low EPAP with longer I:E optimises the patient's BiPAP settings and showed a significant improvement in PAS, RR and tidal volume. BiPAP should be considered as an early treatment in the PED severe or non-responsive moderate asthmatics. Competing Interests: Conflicts of Interest: None declared. (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.) |
| Databáze: | MEDLINE |
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