Comparative study between Nasal Continuous Positive Airway Pressure (Ncpap) and Heated and Humidified High Flow Nasal Canula (HHHNFC) as respiratory support in post extubated infants with acute bronchiolitis in PICU of a tertiary care hospital

Abstract

Background : Background - Acute bronchiolitis is the most common lower-airway viral infection in infants. Mechanical ventilation may be needed by 5(15%) of the hospitalized patients because of fatigue, apnea, or hypoxemia. Inappropriate extubation timing increases morbidity and mortality, ICU stay. To prevent it nCPAP is an established therapy. HHHFNC is an emerging therapy for respiratory support in infants in PICU which can be used as a successful alternative to CPAP. Methods : Randomised control trial, single centre trial, pilot study. Study period: from June 2015 to May 2017. Study was approved by institutional ethical committee for human research. Inclusion criteria - Infants excluding neonates mechanically ventilated due to acute Bronchiolitis fulfilling extubation criteria after performing Spontaneous breathing trial (SBT) by putting patient in CPAP of 5 cmH2o for 30 min as per standard PICU protocol. Exclusion criteria - Infants ventilated due to other respiratory cause and associated heart or neurological impairment, Immmunocompromised patient, having pre-existing chronic respiratory morbidity. The extubated infants were supplemented with face mask oxygen and monitored for HR, RR, SPO2, Respiratory Distress Assessment Index (RDAI) and Arterial Blood Gas (ABG). They were randomized and put on nCPAP or HHHFNC if they shows any one of the following : Increase in HR > 20 b/min and RR > 10/min, RDAI = 11, SpO2 - = 92%, Ph = 7.35 and Pco2= 50mHg. Comfort score and Respiratory Distress Assessment Instrument (RDAI) were recorded 12 hourly. Infants with oxygen requirement more than 70%, pCO2 >65mm of Hg combined with pH Results : Total 170 were hospitalized with the diagnosis of Bronchiolitis during the study period. Thirty six patients required mechanical ventilation and 28 infants aged between 1 month to 12 months were randomized in the study. Twenty one (21/28, 75%) of the included infants were male. Mean (±SD) age of the study population was 3.75(±1.94) months. Two (1/13, 15%) infants of the CPAP arm and two (2/15, 13%) infants of the HHHFNC arm had extubation failure. There was no statistically significant difference between the two groups. RDAI score and total duration of PICU stay between the two groups show comparable results. Comfort score comparison between the two groups shows infants on HHHFNC were more comfortable (p<0.05) Conclusion : HHHFNC is comparable to nCPAP in respect of reducing extubation failure, decreasing respiratory distress or length of hospital stay. But it is more comfortable for infants.