I have a clinical scenario and a question to present:

A 10 year old girl with spastic CP and seizure disorder presents with EMS receiving BVM secondary to apnea following administration of rectal diazepam for seizure. On presentation, she has spontaneous respiratory effort and is placed on NRB. Shortly afterward, she is noted to have worsening hypopnea and additional measures are required to assist ventilation. Is it appropriate to place a patient who has true apnea for this (presumed) etiology on facemask BiPap for a period? Is it OK if she is not overbreathing your set rate at all? Even if the presumption is the benzo, and the assumption is that it will resolve shortly, is true intubation mandated in this circumstance if it will be required for a few hours? The clinical markers used to establish efficacy of the intervention in this case are chest wall excursion, breath sounds, oxygen sats, and nasal in-line end tidal CO2 (no blood gas is yet taken, but will be done so to determine efficacy of intervention). I am curious as to your opinions/experience and if there is any data that you are aware of on Bipap for apnea other than OSA?

Thanks for your thoughts.


Ethan Wiener, MD

PEM, Goryeb Children's Hospital

Morristown, NJ

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