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
Citation Information :
Sinha R, Roychowdhoury S, Mukhopadhyay S, Ghosh P, Dutta K, Ghosh S. 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. Indian J Crit Care Med 2018; 22 (2):85-90.
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.
Ryu JH, Myers JL, Swensen SJ. Bronchiolar disorders. Am J Respir Crit Care Med 2003;168:1277-92.
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.
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.
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.
Lazner MR, Basu AP, Klonin H. Non-invasive ventilation for severe bronchiolitis: Analysis and evidence. Pediatr Pulmonol 2012;47:909-16.
Lee JH, Rehder KJ, Williford L, Cheifetz IM, Turner DA. Use of high flow nasal cannula in critically ill infants, children, and adults: A critical review of the literature. Intensive Care Med 2013;39:247-57.
Wiswell TE, Courtney SE. Noninvasive respiratory support. In: Goldsmith JP, Karotkin EH, editors. Assisted Ventilation of the Neonate. 5th ed. St. Louis: Elsevier Saunders; 2011. p. 140.
Dysart K, Miller TL, Wolfson MR, Shaffer TH. Research in high flow therapy: Mechanisms of action. Respir Med 2009;103:1400-5.
Corneli HM, Zorc JJ, Holubkov R, Bregstein JS, Brown KM, Mahajan P, et al. Bronchiolitis: Clinical characteristics associated with hospitalization and length of stay. Pediatr Emerg Care 2012;28:99-103.
Stephen MS, Elizabeth AS, Michael HS, Michele MM, Ashley SR, Richard TF, et al. Pediatric vascular access and centeses. In: Fuhrman BP, Zimmerman JJ, editors. Pediatric Critical Care. 4th ed. Philadelphia: Elsevier; 2011. p. 139-63.
Royal Children's Hospital, Melbourne, Australia, Clinical Practice Guideline on High Flow Nasal Prong HFNP Oxygen. Available from: http://www.rch.org.au/clinicalguide/index.cfm. [Last updated on 2013 Jul 24; last accessed on 2018 Jan 01].
Bueno Campaña M, Olivares Ortiz J, Notario Muñoz C, Rupérez Lucas M, Fernández Rincón A, Patiño Hernández O, et al. High flow therapy versus hypertonic saline in bronchiolitis: Randomised controlled trial. Arch Dis Child 2014;99:511-5.
Metge P, Grimaldi C, Hassid S, Thomachot L, Loundou A, Martin C, et al. Comparison of a high-flow humidified nasal cannula to nasal continuous positive airway pressure in children with acute bronchiolitis: Experience in a Pediatric Intensive Care Unit. Eur J Pediatr 2014;173:953-8.
Pedersen MB, Vahlkvist S. Comparison of CPAP and HFNC in management of bronchiolitis in infants and young children. Children (Basel) 2017;4. pii: E28.
Jat KR, Mathew JL. Continuous positive airway pressure (CPAP) for acute bronchiolitis in children. Cochrane database of systematic reviews 2015. CD010473.
Oymar K, Bårdsen K. Continuous positive airway pressure for bronchiolitis in a general paediatric ward; a feasibility study. BMC Pediatr 2014;14:122.
Keenan SP, Sinuff T, Cook DJ, Hill NS. Does noninvasive positive pressure ventilation improve outcome in acute hypoxemic respiratory failure? A systematic review. Crit Care Med 2004;32:2516-23.
Schibler A, Pham TM, Dunster KR, Foster K, Barlow A, Gibbons K, et al. Reduced intubation rates for infants after introduction of high-flow nasal prong oxygen delivery. Intensive Care Med 2011;37:847-52.
Ten Brink F, Duke T, Evans J. High-flow nasal prong oxygen therapy or nasopharyngeal continuous positive airway pressure for children with moderate-to-severe respiratory distress?. Pediatr Crit Care Med 2013;14:e326-31.