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

Area of Science:

• Pediatric Emergency Medicine
• Respiratory Care
• Critical Care

Background:

• Pediatric asthma involves bronchospasm and airway obstruction, leading to increased respiratory rate and reduced airflow.
• Aerosol therapy can be ineffective in some asthmatics due to ventilation issues.
• Bilevel positive airway pressure (BiPAP) offers benefits like muscle unloading and bronchodilation but is underused in pediatric emergency departments (PEDs).

Purpose of the Study:

• To evaluate the usage, safety, and effectiveness of BiPAP in a pediatric emergency department (PED).
• To analyze BiPAP settings, patient disposition, and outcomes within a Continuous Quality Improvement Program (CQIP).
• To provide data supporting the earlier implementation of BiPAP for moderate-to-severe pediatric asthma.

Main Methods:

• Descriptive analytics were used to evaluate a PED BiPAP CQIP from 2005 to 2013.
• Data collected included patient usage, safety incidents, BiPAP settings (IPAP, EPAP, I:E ratio), therapeutic response, and patient disposition.
• 1157 pediatric asthma patients were included in the analysis.

Main Results:

• Excellent patient compliance (0.5% intubation rate) was observed with BiPAP.
• Median BiPAP settings were IPAP 18 cmH2O, EPAP 8 cmH2O, and I:E ratio 1.75.
• Significant improvements were noted in Pediatric Asthma Severity score, respiratory rate (decreased), and tidal volume (increased); low PICU admission rates and short PED BiPAP durations for discharged patients were recorded.

Conclusions:

• BiPAP is a safe and effective treatment for pediatric asthma in the emergency department setting.
• The CQIP demonstrated improved patient outcomes, high compliance, and minimal complications.
• Optimized BiPAP settings (higher IPAP, low EPAP, longer I:E) significantly improve patient status, supporting its use as an early intervention.