Randomized Comparison of Helmet CPAP Versus High-Flow Nasal Cannula Oxygen in Pediatric Respiratory Distress

Abstract

Based on our knowledge, the present study is the first research comparing the effects of CPAP and HFNC in respiratory distress resolution in a pediatric intermediate care setting. It aims to identify the most efficient treatment to avoid pediatric ICU admissions and endotracheal intubation and reduce the administration of drugs and days of hospitalization.

Safety and Efficacy of High-flow Nasal Cannula Therapy in the Pediatric Emergency Department

“…41,46,47 In a prospective randomized study conducted on children with respiratory distress (age 1-24 months) in the ED, it has been reported that HFNC was efficient in improving SpO 2 , arterial blood gas PaO 2 , and PaO 2 /FIO 2 significantly. 27 In other studies, it has been found that there was a significant reduction in RR and HR with HFNC therapy. 20,22 HFNC treatment achieved wide popularity especially with reports showing to reduce the rate of intubation and PICU admission.…”

“…Study design, outcome and key results are summarized in Table 1. Seven studies included only children with bronchiolitis [16][17][18][19][20][21][22] , six studies had children with respiratory distress due to any disease [23][24][25][26][27][28] and one study was on children with acute asthma exacerbations. 29 Five studies enrolled children up to 24 months of age 19,20,22,24,27 , four enrolled children up to 18 years of age 23,25,26,28 , four included children up to 12 months of age only [16][17][18]21 , and one enrolled children aged 1 to 14 years.…”

“…Seven studies included only children with bronchiolitis [16][17][18][19][20][21][22] , six studies had children with respiratory distress due to any disease [23][24][25][26][27][28] and one study was on children with acute asthma exacerbations. 29 Five studies enrolled children up to 24 months of age 19,20,22,24,27 , four enrolled children up to 18 years of age 23,25,26,28 , four included children up to 12 months of age only [16][17][18]21 , and one enrolled children aged 1 to 14 years. 29 In five studies, HFNC devices were used with 2 L/kg/min flow rate for infants or children up to 10 kg 17,21,25,28,29 , five studies did not report a specific flow rate 18,20,24,26,27 , in one study, 1 L/ kg/min flow rate was utilized 19 and in one study, both 1 L/kg/ min flow rate and 2 L/kg/min were used.…”

“…29 Five studies enrolled children up to 24 months of age 19,20,22,24,27 , four enrolled children up to 18 years of age 23,25,26,28 , four included children up to 12 months of age only [16][17][18]21 , and one enrolled children aged 1 to 14 years. 29 In five studies, HFNC devices were used with 2 L/kg/min flow rate for infants or children up to 10 kg 17,21,25,28,29 , five studies did not report a specific flow rate 18,20,24,26,27 , in one study, 1 L/ kg/min flow rate was utilized 19 and in one study, both 1 L/kg/ min flow rate and 2 L/kg/min were used. 22 In another study a flow rate of 1-8 L/min was used 16 , and in the last study a flow rate of 4-10 L/min was used for children younger than 24 months of age and 5-50 L/min flow rates in older children.…”

“…23 Four studies compared HFNC to standard oxygen therapy 18,19,21,29 , three evaluated reasons for HFNC therapy failure 24,25,28 , and two studies evaluated the effects of HFNC on intubation and PICU admission rates. 17,23 While two studies tried to determine the safety and efficacy of HFNC therapy 20,26 , one study compared 1 L/kg/min flow rate with 2 L/kg/min 22 , one study compared HFNC to continuous positive airway pressure (CPAP) 27 , and another one measured nasopharyngeal pressures at varying flow rates. 16…”