Continuous negative extrathoracic pressure or continuous positive airway pressure compared to conventional ventilation for acute hypoxaemic respiratory failure in children

Shah, Prakeshkumar S; Ohlsson, Arne; Shah, Jyotsna

doi:10.1002/14651858.cd003699.pub3

Cited by 16 publications

(9 citation statements)

References 46 publications

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“…Over the past decade, concerns regarding the complications of invasive ventilation (IV) have prompted greater use of non-invasive respiratory support (NRS) modes such as continuous positive airway pressure (CPAP) [ 2 – 4 ]. Although the use of NRS has been shown to improve patient outcomes in randomised controlled trials (RCTs) in adult and neonatal intensive care [ 5 – 8 ], there is a dearth of RCTs in the PICU setting [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

FIRST-line support for Assistance in Breathing in Children (FIRST-ABC): a multicentre pilot randomised controlled trial of high-flow nasal cannula therapy versus continuous positive airway pressure in paediatric critical care

et al. 2018

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BackgroundAlthough high-flow nasal cannula therapy (HFNC) has become a popular mode of non-invasive respiratory support (NRS) in critically ill children, there are no randomised controlled trials (RCTs) comparing it with continuous positive airway pressure (CPAP). We performed a pilot RCT to explore the feasibility, and inform the design and conduct, of a future large pragmatic RCT comparing HFNC and CPAP in paediatric critical care.MethodsIn this multi-centre pilot RCT, eligible patients were recruited to either Group A (step-up NRS) or Group B (step-down NRS). Participants were randomised (1:1) using sealed opaque envelopes to either CPAP or HFNC as their first-line mode of NRS. Consent was sought after randomisation in emergency situations. The primary study outcomes were related to feasibility (number of eligible patients in each group, proportion of eligible patients randomised, consent rate, and measures of adherence to study algorithms). Data were collected on safety and a range of patient outcomes in order to inform the choice of a primary outcome measure for the future RCT.ResultsOverall, 121/254 eligible patients (47.6%) were randomised (Group A 60%, Group B 44.2%) over a 10-month period (recruitment rate for Group A, 1 patient/site/month; Group B, 2.8 patients/site/month). In Group A, consent was obtained in 29/33 parents/guardians approached (87.9%), while in Group B 84/118 consented (71.2%). Intention-to-treat analysis included 113 patients (HFNC 59, CPAP 54). Most reported adverse events were mild/moderate (HFNC 8/59, CPAP 9/54). More patients switched treatment from HFNC to CPAP (Group A: 7/16, 44%; Group B: 9/43, 21%) than from CPAP to HFNC (Group A: 3/13, 23%; Group B: 5/41, 12%). Intubation occurred within 72 h in 15/59 (25.4%) of HFNC patients and 10/54 (18.5%) of CPAP patients (p = 0.38). HFNC patients experienced fewer ventilator-free days at day 28 (Group A: 19.6 vs. 23.5; Group B: 21.8 vs. 22.2).ConclusionsOur pilot trial confirms that, following minor changes to consent procedures and treatment algorithms, it is feasible to conduct a large national RCT of non-invasive respiratory support in the paediatric critical care setting in both step-up and step-down NRS patients.Trial registrationclinicaltrials.gov, NCT02612415. Registered on 23 November 2015.Electronic supplementary materialThe online version of this article (10.1186/s13054-018-2080-3) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

FIRST-line support for Assistance in Breathing in Children (FIRST-ABC): a multicentre pilot randomised controlled trial of high-flow nasal cannula therapy versus continuous positive airway pressure in paediatric critical care

et al. 2018

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“…A 2013 Cochrane review concluded that more studies are needed to assess NPV safety and outcomes after it found only one study comparing NPV with NIV in 33 children with bronchiolitis, published only in abstract form. 8,9 Existing literature dedicated to NPV use is limited to small case series or case reports in homogeneous disease states, such as acute lung injury, neuromuscular disorders, 7,10 neuromuscular disorders, 11,12 central hypoventilation, 4 bronchiolitis, 8 heart failure, and postoperative management of congenital heart disease. 6,[13][14][15] No published data on complication rates of NPV in a general pediatric population are available.…”

Section: Introductionmentioning

confidence: 99%

Negative-Pressure Ventilation in Pediatric Acute Respiratory Failure

et al. 2017

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“…In adult and pediatric populations, early extubation is an established procedure after LT in order to reduce complications related to prolonged mechanical ventilation such as increased risk of pneumonia and generalized muscle weakness possibly related to sepsis, need for sedation and curarization during invasive MV, upper airway injury, and sinusitis . In our cohort, extubation in the first 24 hours after PICU admission was possible in 60% of patients.…”

Section: Discussionmentioning

confidence: 91%

CPAP by helmet for treatment of acute respiratory failure after pediatric liver transplantation

Chiusolo

Fanelli

Atti

et al. 2017

Pediatric Transplantation

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ARF after pediatric liver transplantation accounts for high rate of morbidity and mortality associated with this procedure. The role of CPAP in postoperative period is still unknown. The aim of the study was to describe current practice and risk factors associated with the application of helmet CPAP. In this retrospective observational cohort study, 119 recipients were divided into two groups based on indication to CPAP after extubation. Perioperative variables were studied, and determinants of CPAP application were analyzed in a multivariate logistic model. Sixty patients (60/114) developed ARF and were included in the CPAP group. No differences were found between the two groups for primary disease, graft type, and blood product transfused. At multivariate analysis, weight <11 kg (OR = 2.9; 95% CI = 1.1-7.3; P = .026), PaO /FiO <380 before extubation (OR = 5.4; 95% CI = 2.1-13.6; P < .001), need of vasopressors (OR = 2.6; 95% CI = 1.1-6.4; P = .038), and positive fluid balance >148 mL/kg (OR = 4.0; 95% CI = 1.6-10.1; P = .004) were the main determinants of CPAP application. In the CPAP group, five patients (8.4%) needed reintubation. Pediatric liver recipients with lower weight, higher need of inotropes/vasopressors, higher positive fluid balance after surgery, and lower PaO /FiO before extubation were at higher odds of developing ARF needing CPAP application.

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Continuous negative extrathoracic pressure or continuous positive airway pressure compared to conventional ventilation for acute hypoxaemic respiratory failure in children

Cited by 16 publications

References 46 publications

FIRST-line support for Assistance in Breathing in Children (FIRST-ABC): a multicentre pilot randomised controlled trial of high-flow nasal cannula therapy versus continuous positive airway pressure in paediatric critical care

FIRST-line support for Assistance in Breathing in Children (FIRST-ABC): a multicentre pilot randomised controlled trial of high-flow nasal cannula therapy versus continuous positive airway pressure in paediatric critical care

Negative-Pressure Ventilation in Pediatric Acute Respiratory Failure

CPAP by helmet for treatment of acute respiratory failure after pediatric liver transplantation

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