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. 2018 Feb;22(2):85-90.
doi: 10.4103/ijccm.IJCCM_274_17.

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

Mihir Sarkar  1 , Rajasree Sinha  1 , Satyabrata Roychowdhoury  1 , Sobhanman Mukhopadhyay  1 , Pramit Ghosh  2 , Kalpana Dutta  1 , Shibarjun Ghosh  1
Affiliations

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

Mihir Sarkar et al. Indian J Crit Care Med. 2018 Feb.

Abstract

Background: Early initiation of appropriate noninvasive respiratory support is utmost important intervention to avoid mechanical ventilation in severe bronchiolitis.

Aim: This study aims to compare noninvasive continuous positive airway pressure (nCPAP) and hot humidified high-flow nasal cannulae (HHHFNC) as modes of respiratory support in infants with severe bronchiolitis.

Methods: Prospective, randomized, open-label pilot study done in a tertiary-care hospital Pediatric Intensive Care Unit (PICU). Participants: 31 infants (excluding neonates) clinically diagnosed with acute bronchiolitis having peripheral capillary oxygen saturation (SpO2) <92% (with room air oxygen); Respiratory Distress Assessment Index (RDAI) ≥11. Intervention: nCPAP (n = 16) or HHHFNC (n = 15), initiated at enrollment. Primary outcome: Reduction of need of mechanical ventilation assessed by improvements in (i) SpO2% (ii) heart rate (HR); respiratory rate; (iii) partial pressure of carbon dioxide; (iv) partial pressure of oxygen; (v) COMFORT Score; (vi) RDAI from preintervention value. Secondary outcome: (i) total duration of noninvasive ventilation support; (ii) PICU length of stay; and (iii) incidence of nasal injury (NI).

Results: Mean age was 3.41 ± 1.11 months (95% confidence interval 2.58-4.23). Compared to nCPAP, HHHFNC was better tolerated as indicated by better normalization of HR (P < 0.001); better COMFORT Score (P < 0.003) and lower incidence of NI (46.66% vs. 75%; P = 0.21). Improvements in other outcome measures were comparable for both groups. For both methods, no major patient complications occurred.

Conclusion: HHHFNC is an emerging alternative to nCPAP in the management of infants with acute bronchiolitis.

Keywords: Acute respiratory failure; bronchiolitis; high-flow oxygen therapy; respiratory syncytial virus.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Adapted CONSORT flow diagram showing progression of patients through the trial
Figure 2
Figure 2
Primary outcome measures; plot showing difference between two groups
See this image and copyright information in PMC

References

    1. Ryu JH, Myers JL, Swensen SJ. Bronchiolar disorders. Am J Respir Crit Care Med. 2003;168:1277–92. - PubMed
    1. Oakley E, Borland M, Neutze J, Acworth J, Krieser D, Dalziel S, et al. Nasogastric hydration versus intravenous hydration for infants with bronchiolitis: A randomised trial. Lancet Respir Med. 2013;1:113–20. - PubMed
    1. Essouri S, Chevret L, Durand P, Haas V, Fauroux B, Devictor D, et al. Noninvasive positive pressure ventilation: Five years of experience in a Pediatric Intensive Care Unit. Pediatr Crit Care Med. 2006;7:329–34. - PubMed
    1. Javouhey E, Barats A, Richard N, Stamm D, Floret D. Non-invasive ventilation as primary ventilatory support for infants with severe bronchiolitis. Intensive Care Med. 2008;34:1608–14. - PubMed
    1. Lazner MR, Basu AP, Klonin H. Non-invasive ventilation for severe bronchiolitis: Analysis and evidence. Pediatr Pulmonol. 2012;47:909–16. - PubMed

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