Abstract
Background: Multiple non-invasive ventilation (NIV) modalities have been identified that may improve the prognosis of pediatric patients with acute lower respiratory infection (ALRI). However, the effect of NIV in children with ALRI remains inconclusive. Hence, this study aimed to evaluate the efficacy of various NIV strategies including continuous positive airway pressure (CPAP), high flow nasal cannula (HFNC), bilevel positive airway pressure (BIPAP), and standard oxygen therapy in children with ALRI and the need for supplemental oxygen.Methods: Embase, PubMed, Cochrane Library, and Web of Science databases were searched from inception to July 2021. Randomized controlled trials (RCTs) that compared different NIV modalities for children with ALRI and the need for supplemental oxygen were included. Data were independently extracted by two reviewers. Primary outcomes were intubation and treatment failure rates. Secondary outcome was in-hospital mortality. Pairwise and Bayesian network meta-analyses within the random-effects model were used to synthesize data. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework.Results: A total of 21 RCTs involving 5,342 children were included. Compared with standard oxygen therapy, CPAP (OR: 0.40, 95% CrI: 0.16–0.90, moderate quality) was associated with a lower risk of intubation. Furthermore, both CPAP (OR: 0.42, 95% CrI: 0.19–0.81, low quality) and HFNC (OR: 0.51, 95% CrI: 0.29–0.81, low quality) reduced treatment failure compared with standard oxygen therapy. There were no significant differences among all interventions for in-hospital mortality. Network meta-regression showed that there were no statistically significant subgroup effects.Conclusion: Among children with ALRI and the need for supplemental oxygen, CPAP reduced the risk of intubation when compared to standard oxygen therapy. Both CPAP and HFNC were associated with a lower risk of treatment failure than standard oxygen therapy. However, evidence is still lacking to show benefits concerning mortality between different interventions. Further large-scale, multicenter studies are needed to confirm our results.Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=172156, identifier: CRD42020172156.
Highlights
Acute lower respiratory infection (ALRI), such as pneumonia and bronchiolitis, constitute a major cause of respiratory failure in children [1, 2], of whom 15% may need intensive care unit (ICU) care and respiratory support [3]
To avoid airway invasivity related to the intubation, various non-invasive ventilation (NIV) strategies, such as continuous positive airway pressure (CPAP), bilevel positive airway pressure (BIPAP) ventilation, and high flow nasal cannula (HFNC), have been proposed among pediatric patients [8, 9]
There was no obvious indication of asymmetry according to the comparison-adjusted funnel plots (Supplementary Figure 10). In this first network meta-analysis comparing different NIV modalities in children with ALRI, we found that CPAP reduced the risk of intubation when compared to standard oxygen therapy
Summary
Acute lower respiratory infection (ALRI), such as pneumonia and bronchiolitis, constitute a major cause of respiratory failure in children [1, 2], of whom 15% may need intensive care unit (ICU) care and respiratory support [3]. To avoid airway invasivity related to the intubation, various non-invasive ventilation (NIV) strategies, such as continuous positive airway pressure (CPAP), bilevel positive airway pressure (BIPAP) ventilation, and high flow nasal cannula (HFNC), have been proposed among pediatric patients [8, 9]. There were no significant differences between the therapies in terms of intubation and mortality rates This conventional meta-analysis only focused on head-to-head trials of comparison of two interventions without assessing multiple interventions as a whole. This study aimed to evaluate the efficacy of various NIV strategies including continuous positive airway pressure (CPAP), high flow nasal cannula (HFNC), bilevel positive airway pressure (BIPAP), and standard oxygen therapy in children with ALRI and the need for supplemental oxygen
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
