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. 2020 Dec;9(4):248-255.
doi: 10.1055/s-0040-1709656. Epub 2020 Apr 17.

High-Flow Nasal Cannula versus Continuous Positive Airway Pressure in Critical Bronchiolitis: A Randomized Controlled Pilot

Regina Grigolli Cesar  1 , Bibiane Ramos Pinheiro Bispo  1 , Priscilla Helena Costa Alves Felix  1 , Maria Carolina Caparica Modolo  1 , Andreia Aparecida Freitas Souza  1 , Nelson K Horigoshi  1 , Alexandre T Rotta  2
Affiliations

High-Flow Nasal Cannula versus Continuous Positive Airway Pressure in Critical Bronchiolitis: A Randomized Controlled Pilot

Regina Grigolli Cesar et al. J Pediatr Intensive Care. 2020 Dec.

Abstract

We conducted a randomized controlled pilot study in infants with critical bronchiolitis ( n = 63) comparing high-flow nasal cannula (HFNC, n = 35) to continuous positive airway pressure (CPAP, n = 28). The primary outcome was treatment failure, defined as the need for bilevel positive pressure ventilation or endotracheal intubation. Treatment failure occurred in 10 patients (35.7%) in the CPAP group and 13 patients (37.1%) in the HFNC group ( p = 0.88). Pediatric intensive care unit length of stay was similar between the CPAP and HFNC groups (5 [4-7] days and 5 [4-8] days, p = 0.46, respectively). In this pilot study, treatment with HFNC resulted in a rate of treatment failure similar to CPAP.

Keywords: acute respiratory failure; bronchiolitis; continuous positive airway pressure; high-flow nasal cannula; infants; respiratory syncytial virus.

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Conflict of interest statement

Conflict of Interest A.T.R. is a scientific advisory board member for Breas Medical U.S., received honoraria for lecturing and developing educational materials for Vapotherm, Inc., and continues to receive royalties from Elsevier for editorial work on a pediatric critical care textbook. The other authors have no potential conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Treatment group allocation and primary outcomes. CPAP, continuous positive airway pressure; HFNC, high flow nasal cannula; BiPAP, bi-level positive airway pressure.
Fig. 2
Fig. 2
Log rank survival analysis for the occurrence of treatment failure (percentage) over time (hours) in the CPAP (solid line) and HFNC (dashed line) groups. CPAP, continuous positive airway pressure; HFNC, high flow nasal cannula.
See this image and copyright information in PMC

Comment in

  • Truth Has Nothing to Do with the Conclusion, and Everything to Do with the Methodology.
    Modesto I Alapont V, Medina A, Del Villar-Guerra P. Modesto I Alapont V, et al. J Pediatr Intensive Care. 2021 Mar;10(1):83-84. doi: 10.1055/s-0040-1713612. Epub 2020 Jul 21. J Pediatr Intensive Care. 2021. PMID: 33585068 Free PMC article. No abstract available.
  • Response from the Authors.
    Cesar RG, Rotta AT. Cesar RG, et al. J Pediatr Intensive Care. 2021 Sep;10(3):240-242. doi: 10.1055/s-0040-1713611. Epub 2020 Jul 21. J Pediatr Intensive Care. 2021. PMID: 34395045 Free PMC article. No abstract available.

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