Non-invasive ventilation improves respiratory distress in children with acute viral bronchiolitis: a systematic review.

Abstract

Non-invasive ventilation (NIV) is a common treatment for bronchiolitis. However, consensus concerning its efficacy is lacking. The aim of this systematic review was to assess NIV effectiveness to reduce respiratory distress. Secondary objectives were to summarize the effects of NIV, identify predictive factors for failure and describe settings and applications. Literature searches were conducted in MEDLINE/PubMed, PEDro, Cochrane, EMBASE, CINAHL, Web of Science, UpToDate, and SuDoc from 1990 to April 2015. Randomized controlled trials, controlled non-randomized trials and prospective studies of NIV (continuous positive airway pressure [CPAP], bi-level CPAP, or neurally-adjusted ventilator assist) for bronchiolitis in infants younger than 2 years were included. Fourteen studies were included, for a total of 379 children. Of these, 357 were treated with NIV as first intention. Respiratory distress, heart rate, respiratory rate and respiratory effort improved (P<0.05). Results were inconclusive regarding prevention of endotracheal intubation. Few adverse events were reported. NIV reduced carbon dioxide pressure (pCO2) in 10 studies. Two randomized controlled studies reported a decrease of 7 mmHg in pCO2 (P<0.05). Predictive factors of NIV failure were apneas, high pCO2, young age, low weight, elevated heart rate and high pediatric risk of mortality score. NIV is mostly administered through a nasal mask, nasal cannula or helmet, with an initial expiratory positive airway pressure of 7 cmH2O. NIV shows promising results for the reduction of respiratory distress in acute viral bronchiolitis, as shown in several recent studies. However, there is a lack of robust studies to confirm this.