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Noninvasive ventilation use in children has been shown in some trials to be a useful tool to avoid intubation in children with asthma.
Since children with asthma who are intubated have a much higher risk for complications including pneumotharaces and pneumomediastinum this can be a very useful tool.
Bi-Pap is usually started with typical settings of 10 for IPAP and 5 for EPAP and can be titrated up as tolerated to levels of up to 25/20 cm H2O and can be delivered with a set rate or a back up rate.
Albuterol and nebulized epiephrine may be delivered through newer BiPAP machines.
Signs that BiPAP is working include decreased Respiratory Rate, decreased retractions and accesory muscle use, improved oxygenation saturation
References
Noninvasive Ventilation Techniques In The Emergency Department:Applications In Pediatric Patients. Pediatric Emergency Medicine Practice June 2009. Vol 6, No 6