Randomised controlled trial of nasal continuous positive airways pressure (CPAP) in bronchiolitis

Thia, Lena P; McKenzie, S A; Blyth, T; Minasian, Caro; Kozlowska, Wanda; Carr, Siobhán

doi:10.1136/adc.2005.091231

Cited by 163 publications

(115 citation statements)

References 10 publications

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“…Third, acute bronchiolitis leading to PICU admission occurs often in babies aged 1 to 4 months. [2][3][4][5] The median age of our population was higher because in Italy younger babies are often admitted to NICUs owing to a relatively low number of PICUs. 35 Our population also had more severe parenchymal disease than the classic RSV clinical presentation; the high percentage of bacterial coinfection may explain the more severe hypoxia we found.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5] Inflammation triggers the obstruction of small airways, resulting in reduced lung function and rapid, shallow breathing. 4 Up to 8% of infants with acute RSV bronchiolitis are admitted to a PICU needing noninvasive respiratory support (NRS) because of recurrent apnea or acute respiratory failure (ARF).…”

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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“…It includes a heated humidifier similar to those used with IV, that allows the delivery of heated, humidified oxygen at flow rates, of up to 8 L/min for infants, 20 L/min for children, and 40 L/min for adult sized patients without damage to the nasal mucosa. Possible mechanisms of action include precise control of FIO 2 , washing out the anatomical deadspace with oxygen, and delivery of CPAP [24,25].…”

Section: Noninvasive Ventilationmentioning

confidence: 99%

Advances in Ventilatory Support of Critically Ill Children

Chipman

Kacmarek

2012

Curr Pediatr Rep

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Advances in pediatric medical practices often lag behind the progress made in adult patients, primarily because of the limited number of randomized, controlled, clinical trials. Recent advances in mechanical ventilation derived from successful application in adults include neurally adjusted ventilatory assist, noninvasive ventilation, and protective lung strategies. NAVA improves patient/ ventilator synchrony and reduces the work of breathing, which allows for a decreased use of sedation. This should decrease the length of time patients are intubated and mechanically ventilated. The use of noninvasive ventilation eliminates the need for endotracheal tubes and complications associated with them including tracheal injury, pressure ulcers, issues with oral hygiene and ventilator associated pneumonia. Application of lung protective strategies to pediatric patients with acute lung injury and/or ARDS results in increased oxygenation, less lung injury, and improvements in morbidity and mortality.

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“…Uno de los métodos de VNI es la CPAP, que disminuye el trabajo respiratorio y reduce los episodios de apnea 5,6 .L a aplicación de CPAP permite en numerosas ocasiones evitar la intubación endotraqueal y sus complicaciones potenciales, como un mayor riesgo de infección, mayor tiempo de estancia en UCIP, necesidad de administración de sedo-analgesia en dosis mayores y coste económico sanitario más elevado, entre otros 7 . Las situaciones para las que no estaría indicado el empleo de CPAP (ni otras formas de VNI) serían:…”

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Montaje y manejo del sistema helmet-CPAP en lactantes y niños con insuficiencia respiratoria aguda

González

Mayordomo-Colunga

Galán

et al. 2011

Enfermería Intensiva

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Randomised controlled trial of nasal continuous positive airways pressure (CPAP) in bronchiolitis

Abstract: This study suggests that CPAP compared with ST improves ventilation in children with bronchiolitis and hypercapnoea.

Cited by 163 publications

References 10 publications

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

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

Advances in Ventilatory Support of Critically Ill Children

Montaje y manejo del sistema helmet-CPAP en lactantes y niños con insuficiencia respiratoria aguda

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