Improved clinical and economic outcomes in severe bronchiolitis with pre-emptive nCPAP ventilatory strategy

Essouri, Sandrine; Laurent, Marie; Chevret, L.; Durand, Philippe; Ecochard, E.; Gajdos, Vincent; Devictor, Denis; Tissières, Pierre

doi:10.1007/s00134-013-3129-z

Cited by 107 publications

(95 citation statements)

References 31 publications

(5 reference statements)

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“…Their analysis suggests a clinical and cost improvement of nCPAP including a shorter duration of ventilatory support (hazard ratio 1.8, 95 % CI 1.5-2.2, p \ 0.001) and a 3-day reduction in both PICU and hospital length of stay. They estimate savings in their unit of around €700,000/year with this approach [63].…”

Section: Respiratory and Mechanical Ventilationmentioning

confidence: 99%

Year in review in Intensive Care Medicine 2013: III. Sepsis, infections, respiratory diseases, pediatrics

et al. 2014

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Section: Respiratory and Mechanical Ventilationmentioning

confidence: 99%

Year in review in Intensive Care Medicine 2013: III. Sepsis, infections, respiratory diseases, pediatrics

et al. 2014

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“…6 Continuous positive airway pressure (CPAP) is widely provided as first-line NRS by many PICU teams. [7][8][9] In infants, the choice of interface is crucial for NRS success. Currently, pediatric interfaces include nasal cannulas, nasal and facial mask, and pediatric helmet.…”

Section: Respiratory Syncytial Virus (Rsv)mentioning

confidence: 99%

Continuous Positive Airway Pressure With Helmet Versus Mask in Infants With Bronchiolitis: An RCT

et al. 2015

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BACKGROUND: Noninvasive continuous positive airway pressure (CPAP) is usually applied with a nasal or facial mask to treat mild acute respiratory failure (ARF) in infants. A pediatric helmet has now been introduced in clinical practice to deliver CPAP. This study compared treatment failure rates during CPAP delivered by helmet or facial mask in infants with respiratory syncytial virus-induced ARF. METHODS:In this multicenter randomized controlled trial, 30 infants with respiratory syncytial virus-induced ARF were randomized to receive CPAP by helmet (n = 17) or facial mask (n = 13). The primary endpoint was treatment failure rate (defined as due to intolerance or need for intubation). Secondary outcomes were CPAP application time, number of patients requiring sedation, and complications with each interface.RESULTS: Compared with the facial mask, CPAP by helmet had a lower treatment failure rate due to intolerance (3/17 [17%] vs 7/13 [54%], P = .009), and fewer infants required sedation (6/17 [35%] vs 13/13 [100%], P = .023); the intubation rates were similar. In successfully treated patients, CPAP resulted in better gas exchange and breathing pattern with both interfaces. No major complications due to the interfaces occurred, but CPAP by mask had higher rates of cutaneous sores and leaks.CONCLUSIONS: These findings confirm that CPAP delivered by helmet is better tolerated than CPAP delivered by facial mask and requires less sedation. In addition, it is safe to use and free from adverse events, even in a prolonged clinical setting. WHAT'S KNOWN ON THIS SUBJECT:In a previous short-term physiologic randomized controlled trial, continuous positive airway pressure by helmet was feasible and efficient in improving gas exchange in pediatric acute respiratory failure due to bronchiolitis. WHAT THIS STUDY ADDS:Continuous positive airway pressure administered by helmet reduces the rate of noninvasive respiratory support failure and provides longer application time with less sedation than a facial mask. In addition, it is safe to use and free from adverse events.

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“…First, the primary outcome is a composite endpoint comprising criteria for lack of clinical improvement as well as intolerance to the applied intervention, making it difficult to reproduce in other studies and to compare with other trials. It is also arguable whether the primary outcome is really a clinically important outcome; endotracheal intubation would certainly have been one, but the low rate of intubation in bronchiolitis in the current era (<5%) would have necessitated a much larger sample size [7,12]. The duration of non-invasive ventilation (HFNC, CPAP and/or BIPAP) was greater in HFNC patients (98.3 vs 72.9 h, p = 0.2), suggesting that length of ventilation may be a candidate outcome in future trials.…”

mentioning

confidence: 99%

Glass half empty or half full? The story of high-flow nasal cannula therapy in critically ill children

Ramnarayan

Schibler

2017

Intensive Care Med

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Improved clinical and economic outcomes in severe bronchiolitis with pre-emptive nCPAP ventilatory strategy

Abstract: nCPAP in severe bronchiolitis is associated with a significant improvement in patient management as shown by the reduction in invasive care, LOV, PICU LOS, hospital LOS, and economic burden.

Cited by 107 publications

References 31 publications

Year in review in Intensive Care Medicine 2013: III. Sepsis, infections, respiratory diseases, pediatrics

Year in review in Intensive Care Medicine 2013: III. Sepsis, infections, respiratory diseases, pediatrics

Continuous Positive Airway Pressure With Helmet Versus Mask in Infants With Bronchiolitis: An RCT

Glass half empty or half full? The story of high-flow nasal cannula therapy in critically ill children

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