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Question 11:

In the child with an asthma exacerbation in the ED, should CPAP or BiPap be administered to prevent hospitalization, to decrease time in the ED, and/or to improve pulmonary function?

Asthma ED team recommendation:
 The use of Bi-level Positive Airway Pressure (BiPAP) may be utilized to prevent endotracheal intubation in patients with severe asthma exacerbations with impending respiratory failure. We value the prevention of endotracheal intubation in pediatric asthmatics. This recommendation is based upon expert consensus and limited data from very low quality research. Future research on this topic, if performed, is likely to have an important influence on our confidence in the estimate of effect and may change the estimate.

Literature supporting this recommendation: From the literature search performed by the EBP librarian, no articles were identified. However, two studies were identified by review of references of other studies. Beers (2007) is a retrospective chart review of children who were treated with BiPAP after conventional treatment failure. Brandao (2009) is a poorly reported study performed on adults.Evidence does not support:

These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.