Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Oct 22;11(11):1273.
doi: 10.3390/children11111273.

Helmet Continuous Positive Airway Pressure for Acute Bronchiolitis Respiratory Failure in a Pediatric Ward: Is It a Replicable Experience?

Anna Maria Musolino  1 , Sabrina Persia  1 , Maria Chiara Supino  1 , Francesca Stoppa  1 , Lelia Rotondi Aufiero  1 , Raffaella Nacca  1 , Laura Papini  1 , Mara Pisani  1 , Sebastian Cristaldi  1 , Anna Chiara Vittucci  1 , Livia Antilici  1 , Corrado Cecchetti  1 , Massimiliano Raponi  2 , Vinay Nadkarni  3 , Alberto Villani  1   4
Affiliations

Helmet Continuous Positive Airway Pressure for Acute Bronchiolitis Respiratory Failure in a Pediatric Ward: Is It a Replicable Experience?

Anna Maria Musolino et al. Children (Basel). .

Abstract

(1) Background: Helmet Continuous Positive Airway Pressure (H-CPAP) has primarily been used in intensive care settings to treat moderate-to-severe bronchiolitis in infants. We aim to report on the feasibility of H-CPAP for selected infants with bronchiolitis in a pediatric ward. (2) Methods: A retrospective, observational, consecutive case series was studied of 26 patients who received H-CPAP on the pediatric ward from October 2022 to February 2023, including a description of patient outcomes and costs. (3) Results: Of 130 infants with bronchiolitis admitted to Bambino Gesù Hospital in Rome, 34 were hospitalized for moderate to severe bronchiolitis, and 26 began H-CPAP on the ward. Among the 26 pediatric patients who received H-CPAP on the ward, 4 out of 26 (15%) required transfer to the PICU within the first hours of care due to clinical deterioration. No problems with the H-CPAP interface or side effects attributable to H-CPAP were reported. Pharmacological sedation with a single dose of dexmedetomidine was required for 15/26 patients (57%) following failure of non-pharmacological anxiety reduction strategies. After introducing H-CPAP in our pediatric ward, we achieved total cost savings of approximately EUR 147,120. (4) Conclusions: Treatment with H-CPAP for infants with bronchiolitis may be feasible in non-intensive care settings with trained staff, appropriate monitoring, and rapid access to pediatric intensive care.

Keywords: Helmet Continuous Positive Airway Pressure (H-CPAP); bronchiolitis; infant; pediatric ward; respiratory failure.

PubMed Disclaimer

Conflict of interest statement

Vinay Nadkarni is the President of the Society of Critical Care Medicine 2023–2024. The views presented in this manuscript are his, and they are not intended to represent the Society of Critical Care Medicine. The other authors have no relevant financial or non-financial interests to disclose.

Figures

Figure 1
Figure 1
Patient flow chart.
Figure 2
Figure 2
Heart rate values’ distribution at baseline (before H-CPAP) and during H-CPAP therapy. The box-whisker plots show the median (horizontal line), interquartile range (margins of box), and absolute range (vertical line). HR, heart rate (bpm); H-CPAP, Helmet Continuous Positive Airway Pressure.
Figure 3
Figure 3
Respiratory rate values’ distribution at baseline (before H-CPAP) and during H-CPAP therapy. The box-whisker plots show the median (horizontal line), interquartile range (margins of box), and absolute range (vertical line). RR, respiratory rate in breaths per minute (bpm); H-CPAP, Helmet Continuous Positive Airway Pressure.
Figure 4
Figure 4
Rox index values’ distribution at baseline (before H-CPAP) and during H-CPAP therapy. The box-whisker plots show the median (horizontal line), interquartile range (margins of box), and absolute range (vertical line). RR, respiratory rate in breaths per minute (bpm); H-CPAP, Helmet Continuous Positive Airway Pressure.
See this image and copyright information in PMC

References

    1. Zorc J.J., Hall C.B. Bronchiolitis: Recent Evidence on Diagnosis and Management. Pediatrics. 2010;125:342–349. doi: 10.1542/peds.2009-2092. - DOI - PubMed
    1. Nair H., Nokes D.J., Gessner B.D., Dherani M., Madhi P.S.A., Singleton R.J., O’Brien K.L., Roca A., Wright P.P.F., Bruce N., et al. Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: A systematic review and meta-analysis. Lancet. 2010;375:1545–1555. doi: 10.1016/S0140-6736(10)60206-1. - DOI - PMC - PubMed
    1. Caffrey Osvald E., Clarke J.R. NICE clinical guideline: Bronchiolitis in children: Table 1. Arch. Dis. Child. -Educ. Pract. 2016;101:46–48. doi: 10.1136/archdischild-2015-309156. - DOI - PubMed
    1. Ralston S.L., Lieberthal A.S., Meissner H.C., Alverson B.K., Baley J.E., Gadomski A.M., Johnson D.W., Light M.J., Maraqa N.F., Mendonca E.A., et al. Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis. Pediatrics. 2014;134:e1474–e1502. doi: 10.1542/peds.2014-2742. - DOI - PubMed
    1. Lazner M.R., Basu A.P., Klonin H. Non-invasive ventilation for severe bronchiolitis: Analysis and evidence. Pediatr. Pulmonol. 2012;47:909–916. doi: 10.1002/ppul.22513. - DOI - PubMed

LinkOut - more resources