Continuous positive airway pressure for bronchiolitis in a general paediatric ward; a feasibility study

Abstract

BackgroundContinuous positive airway pressure (CPAP) is commonly used to relieve respiratory distress in infants with bronchiolitis, but has mostly been studied in an intensive care setting. Our prime aim was to evaluate the feasibility of CPAP for infants with bronchiolitis in a general paediatric ward, and secondary to assess capillary PCO2 (cPCO2) levels before and during treatment.MethodsFrom May 1st 2008 to April 30th 2012, infants with bronchiolitis at Stavanger University Hospital were treated with CPAP in a general paediatric ward, but could be referred to an intensive care unit (ICU) when needed, according to in-house guidelines. Levels of cPCO2 were prospectively registered before the start of CPAP and at approximately 4, 12, 24 and 48 hours of treatment as long as CPAP was given. We had a continuous updating program for the nurses and physicians caring for the infants with CPAP. The study was population based.Results672 infants (3.4%) were hospitalized with bronchiolitis. CPAP was initiated in 53 infants (0.3%; 7.9% of infants with bronchiolitis), and was well tolerated in all but three infants. 46 infants were included in the study, the majority of these (n = 33) were treated in the general ward only. These infants had lower cPCO2 before treatment (8.0; 7.7, 8.6)(median; quartiles) than those treated at the ICU (n = 13) (9.3;8.5, 9.9) (p < 0.001). The level of cPCO2 was significantly reduced after 4 h in both groups; 1.1 kPa (paediatric ward) (p < 0.001) and 1.3 kPa (ICU) (p = 0.002). Two infants on the ICU did not respond to CPAP (increasing cPCO2 and severe apnoe) and were given mechanical ventilation, otherwise no side effects were observed in either group treated with CPAP.ConclusionTreatment with CPAP for infants with bronchiolitis may be feasible in a general paediatric ward, providing sufficient staffing and training, and the possibility of referral to an ICU when needed.

Nasal Continuous Positive Airway Pressure in Bronchiolitis: A Randomized Controlled Trial

“…The mechanism by which CPAP works in bronchiolitis is likely to be multifactorial. CPAP works by keeping the airways open, increasing clearance of secretion and improving gas exchange [13,14]. Although CPAP has been associated with adverse effects such as nasal mucosal damage, mucosal excoriation, scarring, pressure necrosis, pneumothorax and a decrease in cardiac output [12], none of the patients included in our study had any significant adverse effect.…”

Comparative Study between Noninvasive Continuous Positive Airway Pressure and Hot Humidified High-flow Nasal Cannulae as a Mode of Respiratory Support in Infants with Acute Bronchiolitis in Pediatric Intensive Care Unit of a Tertiary Care Hospital

“…[ 15 ] A study evaluating the feasibility of nCPAP for infants with Bronchiolitis in a pediatric ward, reported a decline in median PaCO 2 after therapy, thus it was concluded that nCPAP may be feasible in such setting, provided sufficient trained staffs and PICU referral setups were available. [ 16 ] Another study reviewing the use of nCPAP (either alone or associated with Heliox) reported a reduction of PaCO2, RR, and the modified Woods clinical asthma score after 1 h of treatment. However, after applying the GRADE system, the quality of evidence for a beneficial effect of nCPAP was considered as low.…”

Non-invasive respiratory support for infants with bronchiolitis: a national survey of practice

“…Nasal continuous positive airway pressure (nCPAP) has been used as a mode of non-invasive respiratory support for infants with bronchiolitis-induced respiratory failure for over two decades [9–13], and is increasingly being used in a ward setting [14]. Recently, high-flow nasal cannula therapy (HFNC) has become a popular alternative [15].…”