Comparison of CPAP and HFNC in Management of Bronchiolitis in Infants and Young Children

Abstract

Continuous positive airway pressure (CPAP) has been used in infants with bronchiolitis for decades. Recently, high flow nasal cannula (HFNC) therapy was introduced We conducted a retrospective study of treatment with CPAP vs. HFNC between 2013 and 2015, comparing the development in respiratory rate, fraction of inspired oxygen (FiO2) and heart rate, treatment failure, duration of treatment, and length of hospital stay. A sample size of 49 children were included. Median age was 1.9 months. Median baseline pCO2 was 7.4 kPa in both groups, respiratory rate per minute was 57 vs. 58 (CPAP vs. HFNC). Respiratory rate decreased faster in the CPAP group (p < 0.05). FiO2 decreased in the CPAP group and increased in the HFNC group during the first 12 h, whereafter it decreased in both groups. (p < 0.01). Heart rate development was similar in both groups. Twelve children (55%) changed systems from HFNC to CPAP due to disease progression. There was no difference in length of treatment, hospital stay, or transmission to intensive care unit between the groups. CPAP was more effective than HFNC in decreasing respiratory rate (RR) and FiO2. No differences were observed in length of treatment or complications. Further studies should be conducted to compare the efficacy of the two treatments of bronchiolitis, preferably through prospective randomized trials.

Noninvasive Ventilation and High-Flow Nasal Cannulae Therapy for Children with Acute Respiratory Failure: An overview

“…Pedersen et al reviewed clinical outcomes among a historical cohort of 49 infants admitted with severe bronchiolitis and treated with CPAP or HFNC. 51 In both groups, respiratory rate declined with treatment; however, improvements in respiratory distress were faster with CPAP treatment. Moreover, in 55% of children, the mode of treatment was changed from HFNC to CPAP due to an increase in respiratory distress.…”

“…47,48 Various studies investigating HFNC use in children and adults are presented in Table 2. 41,45,[49][50][51][52] In Spain, two RCTs involving seven adult ICUs were conducted to assess the effect of using HFNC in the postextubation period on the incidence of reintubation and respiratory failure in high-and low-risk patients, respectively. 49,50 In the first trial, high-risk patients who passed spontaneous breathing trials randomly received either HFNC or conventional NIV while, in the second trial, low-risk patients randomly received either HFNC or conventional oxygen therapy.…”

“…Moreover, in 55% of children, the mode of treatment was changed from HFNC to CPAP due to an increase in respiratory distress. 51 Additionally, a multicentre RCT evaluated the clinical outcomes of infants presenting with moderate-to-severe bronchiolitis, comparing CPAP treatment at a PEEP level of 7 cm of H 2 O to HFNC therapy at a rate of 2 L/minute/kg. 52 Only 5.7% of the infants required intubation, with the rest managed using either HFNC or CPAP.…”

“…Summary of selected studies evaluating the use of high-flow nasal cannulae in children and adults41,45,[49][50][51][52] The rate of intubation in the HFNC group was 38% compared to 50% in the NIV group and 47% in the standard oxygen therapy group…”

Akutes respiratorisches Versagen: nichtinvasive Beatmung im Kindesalter

“…HFNC und CPAP verbessern die Sauerstoffsättigung, senken den CO 2 , reduzieren die Atemfrequenz und die Intubationsrate in kleinen randomisierten kontrollierten Studien (RCT) und einigen Beobachtungsstudien [2,4]. Darüber hinaus verbessert CPAP auch die schwere Dyspnoe und senkt im Vergleich zu HFNC in einer RCT aus dem Jahr 2017 effektiver und schneller Atemfrequenz, Herzfrequenz und F i O 2 [10].…”