Safety and effectiveness of bubble continuous positive airway pressure as respiratory support for bronchiolitis in a pediatric ward

• Published in: European journal of pediatrics Vol. 181; no. 12; pp. 4039 - 4047
• Main Authors: Agüera, Marta, Melé-Casas, Maria, Molina, Maria Mercedes, Pons-Odena, Martí, de-Sevilla, Mariona F., García-García, Juan-José, Launes, Cristian, Monfort, Laura
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-12-2022; Springer Nature B.V
• Subjects: Acute Disease; Bronchiolitis - etiology; Bronchiolitis - therapy; Bronchopneumonia; Child; Children; Clinical trials; Cohort analysis; Cohort Studies; Continuous positive airway pressure; Continuous Positive Airway Pressure - methods; Epidemiology; Heart rate; Hospitals; Humans; Infant; Infants; Intensive care; Mechanical ventilation; Medicine; Medicine & Public Health; Original; Original Article; Oxygen; Oxygen Inhalation Therapy - methods; Patients; Pediatrics; Pressure; Prospective Studies; Respiration; Respiratory Rate; Respiratory tract; Seasons; Statistical analysis; Ventilators; CPAP ventilation; General ward; Pediatric ICU; Invasive mechanical ventilation; Safety; Bronchiolitis
• ISSN: 1432-1076; 0340-6199; 1432-1076
• DOI: 10.1007/s00431-022-04616-3

The results of several clinical trials suggest that continuous positive airway pressure (CPAP) for acute bronchiolitis can be more effective than high-flow nasal cannula (HFNC). The use of HFNC involved a minimum reduction (5%) in admissions to the pediatric intensive care unit (PICU) in our hospital. Our main aim was to evaluate its safety and effectiveness as respiratory support for patients with bronchiolitis in a pediatric general ward. A secondary goal was to compare the admissions to PICU and the invasive mechanical ventilation (IMV) rate of patients treated with HFNC and those treated with HFNC/b-CPAP during the 2018–2019 and 2019–2020 epidemic seasons, respectively. Two prospective single-centre observational studies were performed. For the main aim, a cohort study (CS1) was carried out from 1st of November 2019 to 15th of January 2020. Inclusion criteria were children aged up to 3 months with bronchiolitis treated with b-CPAP support when HFNC failed. Epidemiological and clinical parameters were collected before and 60 min after the onset of CPAP and compared between the responder (R) and non-responders (NR) groups. NR was the group that required PICU admission. One hundred fifty-eight patients were admitted to the ward with bronchiolitis and HFNC. Fifty-seven out of one hundred fifty-eight required b-CPAP. No adverse events were observed. Thirty-two out of fifty-seven remained in the general ward (R-group), and 25/57 were admitted to PICU (NR-group). There were statistically significant differences in respiratory rate (RR) and heart rate (HR) between both groups before and after the initiation of b-CPAP, but the multivariable models showed that the main differences were observed after 60 min of therapy (lower HR, RR, BROSJOD score and FiO2 in the R-group). For the secondary aim, another cohort study (CS2) was performed comparing data from a pre-b-CPAP bronchiolitis season (1st of November 2018 to 15th January 2019) and the b-CPAP season (2019–2020). Inclusion criteria in pre-b-CPAP season were children aged up to 3 months admitted to the same general ward with moderate-severe bronchiolitis and with HFNC support. Admissions to PICU during the CPAP season were significantly reduced, without entailing an increase in the rate of IMV.
Conclusion
: The implementation of b-CPAP for patients with bronchiolitis in a pediatric ward, in whom HFNC fails, is safe and effective and results in a reduction in PICU admissions.
What is Known:
• Bronchiolitis is one of the most frequent respiratory infections in children and one of the leading causes of hospitalization in infants
.
• Several studies suggest that the use of continuous positive airway pressure (CPAP) for acute bronchiolitis can be more effective than the high flow nasal cannula (HFNC). CPAP is a non-invasive ventilation (NIV) therapy used in patients admitted to pediatric intensive care unit (PICU) with progressive moderate-severe bronchiolitis
.
There is little experience in the literature on the use of continuous positive airway pressure (CPAP) for acute bronchiolitis in a general ward
.
What is New:
• CPAP could be safely and effectively used as respiratory support in young infants with moderate-severe bronchiolitis in a general ward and it reduced the rate of patients who required PICU admission
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• Patients' heart and respiratory rate and their FiO2 needs in the first 60 minutes may help to decide whether or not to continue the CPAP therapy in a general ward
.