Optimal level of positive end-expiratory pressure during nasal continuous airway pressure for severe bronchiolitis: a prospective study

Abstract

Background: Nasal continuous positive airway pressure (nCPAP) has been increasingly applied in the pediatric setting. However, there is no uniform standard for setting and titrating positive end-expiratory pressure (PEEP) level, which is paramount to the effectiveness of the treatment. This study aimed to investigate the optimal parameters for nCPAP in the treatment of severe bronchiolitis based on clinical efficacy and pulmonary function parameters.Methods: A before-after prospective study was conducted with a total of 152 study subjects. These 152 hospitalized patients with severe bronchiolitis were treated and observed from December 2018 to February 2019. Comparisons were made between subjects for clinical symptoms, oxygenation improvement, correction of CO 2 retention, degree of airway obstruction and respiratory mechanics improvement between three different positive end-expiratory pressure levels (PEEP).Results: nCPAP could effectively improve the clinical manifestations, blood gas analysis, pulmonary function and respiratory muscle energy consumption. The m-WCAS score, PaCO 2 , TPTEF/TE, VPEF/ VE, respiratory system compliance (Crs) and resistance (Rrs) were significantly different at different PEEP levels (P<0.05). Although there were no hemodynamic changes at peep parameter levels in the three groups.Group 2 (PEEP: 6 cmH 2 O) had optimal clinical effects, and improvement in airway obstruction and respiratory mechanics compared with the group 1 (PEEP: 4 cmH 2 O) and the group 3 (PEEP: 7 cmH 2 O).Conclusions: PEEP of 6 cmH 2 O via nCPAP is considered as the optimal level in the treatment of infants with severe bronchiolitis.

Respiratory effort during noninvasive positive pressure ventilation and continuous positive airway pressure in severe acute viral bronchiolitis

“…[1][2][3][4] Continuous positive airway pressure (CPAP) has shown its effectiveness to reduce the work of breathing (WOB) in infants with acute bronchiolitis 5,6 and is nowadays largely recommended as a first line treatment of bronchiolitis respiratory failure. [4][5][6][7] Noninvasive positive pressure ventilation (NIPPV), by delivering an additional positive pressure during inspiration with the aim to reduce the patient's respiratory effort to a greater extent than CPAP, 8 is increasingly used in case of CPAP failure and has been shown to be associated with a reduced need of invasive ventilation in case of hypoxic respiratory failure. [9][10][11][12] However, its effectiveness may be limited because of patient-ventilator asynchrony (PVA).…”