Abstract
Continuous positive airway pressure (CPAP) has been used in infants with bronchiolitis for decades. Recently, high flow nasal cannula (HFNC) therapy was introduced We conducted a retrospective study of treatment with CPAP vs. HFNC between 2013 and 2015, comparing the development in respiratory rate, fraction of inspired oxygen (FiO2) and heart rate, treatment failure, duration of treatment, and length of hospital stay. A sample size of 49 children were included. Median age was 1.9 months. Median baseline pCO2 was 7.4 kPa in both groups, respiratory rate per minute was 57 vs. 58 (CPAP vs. HFNC). Respiratory rate decreased faster in the CPAP group (p < 0.05). FiO2 decreased in the CPAP group and increased in the HFNC group during the first 12 h, whereafter it decreased in both groups. (p < 0.01). Heart rate development was similar in both groups. Twelve children (55%) changed systems from HFNC to CPAP due to disease progression. There was no difference in length of treatment, hospital stay, or transmission to intensive care unit between the groups. CPAP was more effective than HFNC in decreasing respiratory rate (RR) and FiO2. No differences were observed in length of treatment or complications. Further studies should be conducted to compare the efficacy of the two treatments of bronchiolitis, preferably through prospective randomized trials.
Highlights
Every winter, bronchiolitis due to respiratory syncytial virus (RSV) or other viruses is a common cause of hospitalization in infants and young children
During the two winter seasons between 2013 and 2015, 27 children were treated with continuous positive airway pressure (CPAP) and 22 with high flow nasal cannula (HFNC)
All children were in CPAP; in the second period 22 and 9 patients were treated by HFNC and CPAP, respectively
Summary
Bronchiolitis due to respiratory syncytial virus (RSV) or other viruses is a common cause of hospitalization in infants and young children. Bronchiolitis presents with coughing, wheezing, retractions, mucus blocking of the airways, increased respiratory rate and work, need of oxygen supply, and feeding difficulties. In Denmark, treatment with continuous positive airway pressure (CPAP) is standard for infants with moderate-severe bronchiolitis and respiratory fatigue. The mechanism of CPAP is not fully understood, but the positive pressure is thought to decrease the inspiratory resistance and thereby relieve muscuar work and improve alveolar ventilation [2] It has been shown to abolish airway occlusion and increase diaphragmatic tone [3] CPAP has been shown to be superior to standard care in improving clinical outcomes and decreasing pCO2 [4,5]. Evidence is scarce and two reviews, among them a Cochrane review [6,7], have concluded that more randomized trials are needed in evaluating the efficacy of CPAP in bronchiolitis
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