86 Nasal Continuous Airway Pressure Versus Helmet Continuous Airway Pressure in Infants with Bronchiolitis: A Crossover Study

Abstract

Objective: To compare the efficacy and safety of CPAP delivered by helmet interface (HI) and CPAP delivered by Infant-Flow® system (IF) with nasal prongs.Methods: Prospective crossover study including infants < 3 months of age with refractory bronchiolitis. Patients with a modified Wood's clinical asthma score (M-WCAS)≥4 or venous PCO2≥60 mmHg despite nebulized adrenalin were eligible. Infants were randomly allocated to receive CPAP by HI or IF during one hour, and then switched to the other CPAP system. Measurements were taken at baseline and after 60 and 120 minutes. After this period, CPAP was maintained with the system used in the second phase of the crossover period.Results: Fifteen patients fulfilled inclusion criteria: 8 males, age 50.8±15.7 (mean±SD) days, weight 4.4±0.7 kg. Nine infants received HI-CPAP in the first crossover phase and 6 received IF-CPAP initially. Baseline mean values were: M-WCAS 4.6±1 points; venous PCO257±10.4 mmHg, heart rate (HR) 173±15.2 beats/minute; respiratory rate (RR) 56.2±11.2 breaths/minute. After 120 minutes of CPAP, clinical score, HR and RR fell 1.9 points, 15 beats/minute, and 8 breaths/minute, respectively (p< 0.05). At 60 minutes, improvement in clinical score (3±0.9 vs. 2.8±1), HR (166±21.5 vs. 160.2±13.3) and RR (47.3±18.5 vs. 47.3±11.1) was similar in both groups (p>0.05). No adverse effects were recorded during the crossover period; later, two patients required intubation: one belonged to IF group and the other one to HI group.Conclusions: HI-CPAP was as effective as IF-CPAP in infants with acute bronchiolitis. Safety of both systems seems to be similar.