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

ObjectiveIn 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 sh...

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Bibliographic Details
Published in:BMJ open 2017-01, Vol.7 (1), p.e011845-e011845
Main Authors: Abramo, Thomas, Williams, Abby, Mushtaq, Samaiya, Meredith, Mark, Sepaule, Rawle, Crossman, Kristen, Burney Jones, Cheryl, Godbold, Suzanne, Hu, Zhuopei, Nick, Todd
Format: Article
Language:English
Subjects:
Adolescent
Aerosols
Airway management
Asthma
Asthma - therapy
Bronchodilators
Child
Chronic obstructive pulmonary disease
Clinical medicine
Clinical trials
Emergency medical care
Emergency Medicine
Emergency Service, Hospital
Female
Hospitals
Hospitals, Pediatric
Humans
Intensive care
Male
Patient safety
Patients
Pediatrics
Positive-Pressure Respiration - methods
Quality
Quality improvement
Quality Improvement - statistics & numerical data
Total quality
Treatment Outcome
Trends
Ventilators
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Summary:ObjectiveIn 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.InterventionsPED BiPAP CQIP descriptive analytics.SettingAcademic PED.Participants1157 patients.InterventionsA 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 outcomesSafety, usage, compliance, therapeutic response parameters, BiPAP settings and patient disposition.Results1157 patients had excellent compliance without complications. Only 6 (0.5%) BiPAP patients were intubated. BiPAP median settings: IPAP 18 (16,20) cm H2O range 12–28; EPAP 8 cmH2O (8,8) range 6–10; inspiratory-to-expiratory time (I:E) ratio 1.75 (1.5,1.75). Pediatric Asthma Severity score and RR decreased (p
ISSN:2044-6055
2044-6055
DOI:10.1136/bmjopen-2016-011845