High Continuous Positive Airway Pressure Research Articles

Assessing the predictors for paediatric intensive care unit for inter-hospital transfer patients on high-flow nasal cannula or continuous positive airway pressure ventilation at a tertiary Australian paediatric hospital.

The aim of the present study was to assess the predictors of need for paediatric intensive care unit (PICU) admission for inter-hospital transfer patients to a tertiary paediatric hospital ED on high flow (HF) or continuous positive airway pressure (CPAP) ventilation. Single-centre retrospective study of patients transferred to the state's tertiary paediatric hospital. Demographic information and disease management information was obtained. Between October 2021 and September 2022, 53 patients were transferred to the tertiary hospital on HF or CPAP. Of these, 23 required admission to PICU. Those admitted to PICU had a higher median fraction of inspired oxygen than those not admitted (0.4 vs 0.3, respectively, P = 0.013). Patients transported by road (vs flight) were more likely (20/23 patients, RR = 3.15, P = 0.016) to be admitted to PICU (56% vs 18%). Those who had received CPAP prior to or during transfer were more likely to require PICU admission (P = 0.012). We have demonstrated that children who require CPAP to manage their respiratory disease are more likely to require PICU care on transfer to the tertiary paediatric hospital. In addition, those patients being transferred from secondary metropolitan hospitals after a trial of HF are also likely to require PICU care. This suggests that these patients should be directly admitted to PICU, allowing for improved patient experience and flow as well as reducing unnecessary ED resource utilisation.

Assessing the predictors for paediatric intensive care unit for inter-hospital transfer patients on high-flow nasal cannula or continuous positive airway pressure ventilation at a tertiary Australian paediatric hospital.

The aim of the present study was to assess the predictors of need for paediatric intensive care unit (PICU) admission for inter-hospital transfer patients to a tertiary paediatric hospital ED on high flow (HF) or continuous positive airway pressure (CPAP) ventilation. Single-centre retrospective study of patients transferred to the state's tertiary paediatric hospital. Demographic information and disease management information was obtained. Between October 2021 and September 2022, 53 patients were transferred to the tertiary hospital on HF or CPAP. Of these, 23 required admission to PICU. Those admitted to PICU had a higher median fraction of inspired oxygen than those not admitted (0.4 vs 0.3, respectively, P = 0.013). Patients transported by road (vs flight) were more likely (20/23 patients, RR = 3.15, P = 0.016) to be admitted to PICU (56% vs 18%). Those who had received CPAP prior to or during transfer were more likely to require PICU admission (P = 0.012). We have demonstrated that children who require CPAP to manage their respiratory disease are more likely to require PICU care on transfer to the tertiary paediatric hospital. In addition, those patients being transferred from secondary metropolitan hospitals after a trial of HF are also likely to require PICU care. This suggests that these patients should be directly admitted to PICU, allowing for improved patient experience and flow as well as reducing unnecessary ED resource utilisation.

Non-Invasive High Frequency Oscillatory Ventilation versus Continuous Positive Airway Pressure in Preterm Neonates With Respiratory Distress Syndrome

Abstract Background Respiratory distress syndrome (RDS) is the main cause of respiratory failure in preterm neonates, its incidence varies from 80% to 25% depending on gestational age. When optimal prenatal care is provided, the best approach to treat RDS, according to several recent trials, consists of providing continuous positive airway pressure (CPAP) from the first minutes of life using short binasal prongs or masks, followed by early selective surfactant administration for babies with worsening oxygenation and/or increasing work of breathing. Any effort must be done to minimize the time under invasive mechanical ventilation (IMV). Non-invasive high-frequency oscillatory ventilation (nHFOV) is a new mode of non-invasive ventilation that connects non-invasive circuits to high-frequency ventilators, through which gas exchange is achieved by the superposition of high-frequency oscillation over continuous positive flow. Compared with other non-invasive ventilation modes, nHFOV combines the advantages of nCPAP and high-frequency ventilation, making it more effective at maintaining alveolar stability, eliminating CO2, and limiting barotrauma. Objective To investigate the effectiveness of nasal high frequency oscillatory ventilation in comparison to nCPAP as a primary mode of respiratory support in preterm neonates with respiratory distress syndrome. Methods This randomized controlled trial that was conducted on 90 neonates diagnosed with RDS at the Neonatal Intensive Care Units (NICUs), Ain Shams University Hospitals throughout six months. Results In the current study, there was a significant decrease in FiO2 needs in nHFOV group vs. nCPAP group, the median (IQR) (30% (21 to 37) vs. 31% (30 to 40) respectively, P-value=0.030), but non significant difference in RDS according to total Silverman score in nHFOV group vs. nCPAP group with median (IQR) total Silverman score (4 (4 to 5)vs. 4 (3 to 6) respectively, P-value= 0.474). Conclusion Using nHFOV is better than nCPAP in decreasing the need of FiO2.

Association Between Obstructive Sleep Apnea (OSA) Severity and Optimal Continuous Positive Airway Pressure (CPAP); Do Severe OSA Patients Always Need High CPAP Pressure?

Objective: Obstructive sleep apnea (OSA) is a prevalent sleep disorder associated with an increased risk of cardiovascular disease. Severity of OSA is assessed using the apnea-hypopnea index (AHI), but the optimal continuous positive airway pressure (CPAP) does not always correlate proportionally with AHI. This study aims to identify factors leading to the need for high CPAP pressure despite low AHI or vice versa.Methods: The study includes 91 patients diagnosed with OSA through polysomnography. Participants undergoing CPAP titration were categorized in three groups based on AHI (30/h) and optimal CPAP pressure (10 cm H<sub>2</sub>O); low AHI and high CPAP pressure group (LH group), high AHI and low CPAP pressure group (HL group), direct proportion group (DP group). The Kruskal–Wallis nonparametric statistical test is used to identify significant differences between the three groups.Results: Among the subjects, 78% were male, with no significant age or BMI differences between groups. There were 36 (39.6%) subjects with mild to moderate OSA and 55 (60.4%) subjects with severe OSA. The study revealed that patients requiring high CPAP pressure despite low AHI (LH group) had lower AHI, oxygen desaturation index, and various other parameters compared to other groups as expected. However, certain factors like the percentage of hypopnea in AHI, limb movement (LM) arousal index, and spontaneous arousal index were higher in the LH group.Conclusion: Patients with mild to moderate OSA requiring high CPAP pressure are more likely associated with specific aspects such as hypopnea in AHI, LM arousal, and spontaneous arousal index, presenting unpredictable outcomes.

CPAP Versus NIPPV Postextubation in Preterm Neonates: A Comparative-Effectiveness Study.

Nasal intermittent positive pressure ventilation (NIPPV) has been shown to be superior to nasal continuous positive airway pressure (CPAP) postextubation in preterm neonates. However, studies have not permitted high CPAP pressures or rescue with other modes. We hypothesized that if CPAP pressures >8 cmH2O and rescue with other modes were permitted, CPAP would be noninferior to NIPPV. We conducted a pragmatic, comparative-effectiveness, noninferiority study utilizing network-based real-world data from 22 Canadian NICUs. Centers self-selected CPAP or NIPPV as their standard postextubation mode for preterm neonates <29 weeks' gestation. The primary outcome was failure of the initial mode ≤72 hours. Secondary outcomes included failure ≤7 days, and reintubation ≤72 hours and ≤7 days. Groups were compared using a noninferiority adjusted risk-difference (aRD) margin of 0.05, and margin of no difference. A total of 843 infants extubated to CPAP and 974 extubated to NIPPV were included. CPAP was not noninferior (and inferior) to NIPPV for failure of the initial mode ≤72 hours (33.0% vs 26.3%; aRD 0.07 [0.03 to 0.12], Pnoninferiority(NI) = .86), and ≤7 days (40.7% vs 35.8%; aRD 0.09 [0.05 to 0.13], PNI = 0.97). However, CPAP was noninferior (and equivalent) to NIPPV for reintubation ≤72 hours (13.2% vs 16.1%; aRD 0.01 [-0.05 to 0.02], PNI < .01), and noninferior (and superior) for reintubation ≤7 days (16.4% vs 22.8%; aRD -0.04 [-0.07 to -0.001], PNI < .01). CPAP was not noninferior to NIPPV for failure ≤72 hours postextubation; however, it was noninferior to NIPPV for reintubation ≤72 hours and ≤7 days. This suggests CPAP may be a reasonable initial postextubation mode if alternate rescue strategies are available.

Effect of high flow nasal cannula and continuous positive airway pressure on the sleep apnea-specific hypoxic burden and pulse rate response in children with Obstructive Sleep Apnea

Effect of high flow nasal cannula and continuous positive airway pressure on the sleep apnea-specific hypoxic burden and pulse rate response in children with Obstructive Sleep Apnea

Comparison of High Flow Nasal Cannula and Continuous Positive Airway Pressure in COVID-19 Patients With Acute Respiratory Distress Syndrome in Critical Care Unit: A Randomized Control Study.

Background and objective Acute hypoxic respiratory failure in coronavirus disease 2019 (COVID-19) pneumonia has been treated with oxygen delivered by oxygen masks and non-invasive ventilation (NIV) with continuous positive airway pressure (CPAP), and more recently with high-flow nasal cannula (HFNC) devices. There is a paucity of randomized controlled trials to compare the efficacy of CPAP with HFNC in COVID-19 pneumonia. We conceptualized a randomized control study to compare the efficacy of HFNC and CPAP in reducing the need for invasive mechanical ventilation, estimation of mechanical ventilation-free days, and risk of intubation in COVID-19 patients with hypoxic respiratory failure. Methodology One hundred consecutive patients who satisfied the inclusion criteria were included in the trial. The patients were then randomly allocated to receive either CPAP or HFNC with settings as per the study protocol. The patients were deemed to have achieved the study endpoint when they were intubated due to any reason or successfully weaned from NIV to conventional oxygen therapies. The number of patients who required invasive ventilation and the number of invasive ventilation-free days were recorded and analyzed. Results Nineteen (38%) patients in the CPAP group and 30 (60%) patients in the HFNC group required invasive mechanical ventilation and the difference was statistically significant (p = 0.03, 95%CI: 0.1829-0.9129). The median number of days free of invasive mechanical ventilation in the CPAP group (median=5 (interquartile range (IQR(=5,6)) was more than in the HFNC group (median=4 (IQR=3,4)) and this difference was statistically significant (p<0.000). The secondary analysis of risk evaluation for intubation done using the Cox regression model showed no significant factors that could have contributed to intubation in the study population. The Kaplan-Meyer curve was used to express the probability of a patient getting intubated and the calculated hazard ratio was 2.29. Conclusion The administration of CPAP significantly reduced the intubation rate and prolonged invasive mechanical ventilation-free period in COVID-19 patients with hypoxic respiratory failure. We also inferred a two-fold increase in the risk of intubation in patients receiving HFNC compared to CPAP.

High flow nasal oxygen vs. continuous positive airway pressure in acute hypoxemic respiratory failure: the missing direct comparison.

High flow nasal oxygen vs. continuous positive airway pressure in acute hypoxemic respiratory failure: the missing direct comparison.

High flow nasal cannula for respiratory support in term infants.

High flow nasal cannula for respiratory support in term infants.

Continuous Positive Airway Pressure plus Mandibular Advancement Therapy (PAPMAT): study protocol for an adaptive randomised crossover trial comparing the benefits and costs of combining two established treatments for obstructive sleep apnoea

BackgroundObstructive sleep apnoea (OSA) involves repeated breathing pauses during sleep due to upper airway obstruction. It causes excessive daytime sleepiness and has other health impacts. Continuous positive airway pressure (CPAP) therapy is effective first line treatment for moderate to severe OSA. Unfortunately, many patients have difficulty tolerating CPAP and pressure intolerance is probably an important contributing factor. Mandibular advancement devices (MAD) are an alternative to CPAP. They are worn in the mouth during sleep to reduce airway obstruction. There is some evidence that, when used in combination with CPAP, MADs improve airway anatomy enough to reduce the CPAP pressure required to treat OSA and that this combination therapy could improve CPAP adherence.MethodsConsecutive patients starting on CPAP for moderate to severe OSA will be recruited at a regional NHS sleep service. Patients with high CPAP pressure requirements after initial titration, who satisfy all entry criteria and consent to participate, will undertake a 2-arm randomised crossover trial. The arms will be (i) standalone CPAP and (ii) CPAP + MAD therapy. Each arm will last 12 weeks, including 2 weeks acclimatisation. CPAP machines will be auto-titrating and with facility for data download, so the impact of MAD on CPAP pressure requirements and CPAP adherence can be easily measured. The primary outcome will be CPAP adherence. Secondary outcomes will include measures of OSA severity, patient-reported outcome measures including subjective daytime sleepiness, quality of life, and treatment preference at the trial exit and health service use. Cost-effectiveness analyses will be undertaken.DiscussionIf the intervention is shown to be effective and cost-effective in improving adherence in this standard CPAP-eligible OSA patient population it would be relatively straightforward to introduce into existing OSA treatment pathways, within the wider NHS and more widely. Both MAD and CPAP are already used by sleep services so their combination would require only minor adjustments to existing clinical pathways. It would be straightforward to disseminate the results of the study through regional, national, and international respiratory meetings. The health economics analysis would provide cost-effectiveness data to inform service planning and clinical guidelines through policy briefing papers, including those by NICE and SIGN.Trial registrationPAPMAT was registered with ISRCTN prior to recruitment beginning (ISRCTN Registry 2021): https://www.isrctn.com/ISRCTN33966032. Registered on 17th November 2021.

Encouraging Continuous Positive Airway Pressure Adherence With Personalized Strategies

Objectives: This study aimed to elucidate whether a comprehensive intervention focusing on individual characteristics could enhance adherence to Continuous Positive Airway Pressure (CPAP) in patients with Obstructive Sleep Apnea (OSA).Methods: We conducted a single-arm, pilot intervention study, recruiting participants aged ≥20 years with suspected OSA. All participants underwent split-night polysomnography and received standardized CPAP treatment. We identified five categories of factors contributing to poor CPAP adherence: mouth breathing, high CPAP pressure causing sleep initiation difficulties, bradypnea or hyperpnea before sleep onset, postarousal central apnea, and nasal dryness and obstruction. We objectively measured CPAP adherence data at 1, 3, 6 and 12 months after a comprehensive intervention targeting individual characteristics. We analyzed the trends in CPAP adherence rates over 1 year.Results: A total of 48 participants (74.0% males; 56.9±13.9 years old) were followed up for 12 months. CPAP adherence rate was 77.1% at 1 month; declined to 60.4%, 39.6%, and 31.3% at 3, 6, and 12 months, respectively. There was no significant difference in demographic and psychological factors, sleep-related symptoms, and sleep characteristics between the adherence and the non-adherence groups. Low body mass index was an independent risk factor affecting CPAP adherence (odds ratios 0.78, &lt;i&gt;p&lt;/i&gt;=0.04).Conclusions: Although our study did not yield significant improvements in CPAP adherence through the comprehensive intervention that targeted individual characteristics, it is significant because it attempted to provide a multidimensional approach to intervention, rather than targeting a single aspect, in promoting CPAP adherence.

Predictors of Adherence to Continuous Positive Airway Pressure in Older Adults With Apnea and Amnestic Mild Cognitive Impairment.

Almost 60% of adults with amnestic mild cognitive impairment (aMCI) have obstructive sleep apnea (OSA). Treatment with continuous positive airway pressure (CPAP) may delay cognitive decline, but CPAP adherence is often suboptimal. In this study, we report predictors of CPAP adherence in older adults with aMCI who have increased odds of progressing to dementia, particularly due to Alzheimer's disease. The data are from Memories 2, "Changing the Trajectory of Mild Cognitive Impairment with CPAP Treatment of Obstructive Sleep Apnea." Participants had moderate to severe OSA, were CPAP naïve, and received a telehealth CPAP adherence intervention. Linear and logistic regression models examined predictors. The 174 participants (mean age 67.08 years, 80 female, 38 Black persons) had a mean apnea-hypopnea index of 34.78, and 73.6% were adherent, defined as an average of ≥4 hours of CPAP use per night. Only 18 (47.4%) Black persons were CPAP adherent. In linear models, White race, moderate OSA, and participation in the tailored CPAP adherence intervention were significantly associated with higher CPAP use at 3 months. In logistic models, White persons had 9.94 times the odds of adhering to CPAP compared to Black persons. Age, sex, ethnicity, education, body mass index, nighttime sleep duration, daytime sleepiness, and cognitive status were not significant predictors. Older patients with aMCI have high CPAP adherence, suggesting that age and cognitive impairment should not be a barrier to prescribing CPAP. Research is needed to improve adherence in Black patients, perhaps through culturally tailored interventions.

A randomized controlled trial to compare the success rates and efficacy of high flow nasal cannulae versus nasal continuous positive airway pressure in post extubation period in neonates

Background: Nasal continuous positive airway pressure (nCPAP) is the mainstay for non-invasive respiratory support for all respiratory distress neonates. Recent advances in Heated humidified high flow nasal cannula (HHHFNC) usage with enhanced humidity, and improved comfort factors have led to its widespread use, at times replacing nCPAP in many neonatal settings. The present study was to assess the efficacy and safety of HHHFNC compared with nCPAP for non-invasive respiratory support in post-extubation period. Methods: A hospital based randomized controlled trial was conducted in neonatal intensive care unit (NICU) of S. Nijalingappa Medical College and HSK Hospital, Bagalkot from January 2019 to June 2020. 140 post-extubated neonates were enrolled for the study after obtaining informed consent from parents, and those who were directly extubated to no support and with major congenital anomalies were excluded from the study. Randomization was done by computer generated random number allocation method. Results: Of the140 babies, 60% were males and 40% were females. Out of 84 male neonates, 47 (67.1%) were on nCPAP and 37 (32.9%) on HHHFNC and out of 56 female neonates 23 (32.9%) were on nCPAP and 33 (47.1%) on HFNC. In this study, 4 babies on nCPAP required re-intubation within 72 hours. 5 babies on HHHFNC, 3 babies required re-intubation within 72 hours and 2 babies within 5 days. The incidence of nasal trauma, hospital stay and duration of NIV support were less in HHHFNC group as compared to nCPAP group. Conclusions: HHHFNC therapy is as effective as nCPAP therapy for the facilitation of extubation in neonates.

L'ossigenoterapia

Oxygen supplementation represents a fundamental therapy in several clinical conditions, both acute and chronic. Starting from some concepts of respiratory physiopathology, this paper discusses the approach to a child with respiratory distress and respiratory failure, focuses on the main signs and symptoms of hypoxia, hypercapnia and increased work of breathing and explains the methods to assess the severity of the clinical status, highlighting the relevance of the SpO2/FiO2 ratio (peripheral oxygen saturation/inspiratory oxygen fraction). Furthermore, this work aims to summarize the main methods of oxygen delivery, their relative indications, by underlining advantages and possible complications such as blow-by oxygen, low flow nasal cannula and face mask (simple, Venturi, rebreathing and non-rebreathing). The focus is on two new oxygen delivery devices, High Flow Nasal Cannula (HFNC) and Continuous Positive Airway Pressure (CPAP), which in recent years have more and more been used not only in emergency units but also in paediatric wards.

Do severe obstructive sleep apnea patients always need high continuous positive airway pressure?

Do severe obstructive sleep apnea patients always need high continuous positive airway pressure?

Thresholds for surfactant use in preterm neonates: a network meta-analysis

ObjectiveTo perform a network meta-analysis of randomised controlled trials of different surfactant treatment strategies for respiratory distress syndrome (RDS) to assess if a certain fraction of inspired oxygen (FiO2) is...

Respiratory emergency simulation teaching (REST) in a multidisciplinary team (MDT)

During the COVID-19 pandemic our respiratory high dependency unit (RHDU) increased bed capacity by 200%, recruited new staff to provide high flow nasal oxygen (HFNO) and continuous positive airway pressure (CPAP) support, and was relocated within the hospital. This created the need to upskill new staff to provide level 2 care to sick patients in a new environment [1]. We aimed to provide training to nurses, healthcare assistants (HCA), and junior doctors on RHDU via a multidisciplinary (MDT) simulation programmed to manage deteriorating respiratory patients. We also aimed to identify gaps in learning, policy, and procedures due to the relocation of RHDU. The pilot included 22 sessions of in-situ simulation, run weekly by a core faculty including a respiratory consultant, ward sister, senior HCA, and clinical educator. All scenarios focused on MDT working with effective assessments and handovers. All staff members on the ward wore the same scrubs making it challenging to identify the job role or seniority of staff, and this was noticeable during the simulations. Coloured lanyards identifying job role were purchased and are now worn by all RHDU staff. An anaphylaxis simulation identified a time delay in finding the key to access emergency medication. A key safe has been purchased by the ward to house this key, ensuring it is always available in an emergency. The themes identified were: an increase in the confidence, competence, and knowledge of the MDT in recognising, responding, and treating medical emergencies. It also developed the working relationships between MDT members by highlighting the skill set of different professions, allowing for an exchange of knowledge across all working levels. Simulation is an excellent resource in problem solving and teaching. It provides a safe place to practise new skills and breaks down the barriers to effective communication within the MDT by creating a cohesive learning environment. Simulation must be an ongoing development for staff to ensure that skills are honed resulting in the best outcomes for our patients in an acute emergency. A monthly training programme has been developed consisting of four hours of simulation-based training using different levels of fidelity. We will continue to employ the use of MDT working to reflect real life working conditions based on the success of this pilot. 1. Almomani E, Sullivan J, Hajjieh M, Leighton K. Simulation-based education programme for upskilling non-critical care nurses for COVID-19 deployment. BMJ Simulation &amp; Technology Enhanced Learning. 2020;7(5): 319–322.

Toward Optimal High Continuous Positive Airway Pressure as Postextubation Support in Preterm Neonates: A Retrospective Cohort Study.

This study aimed to evaluate whether the initial pressure level on high continuous positive airway pressure (CPAP; ≥9 cm H2O), in relation to preextubation mean airway pressure (Paw), influences short-term clinical outcomes in preterm neonates. In this retrospective cohort study, preterm neonates <29 weeks' gestational age (GA) extubated from mean Paw ≥9 cm H2O and to high CPAP (≥9 cm H2O) were classified into "higher level CPAP" (2-3 cm H2O higher than preextubation Paw) and "equivalent CPAP" (-1 to +1 cm H2O in relation to preextubation Paw). Only the first eligible extubation per infant was analyzed. The primary outcome was failure within ≤7 days of extubation, defined as any one or more of (1) need for reintubation, (2) escalation to an alternate noninvasive respiratory support mode, or (3) use of CPAP >preextubation Paw + 3 cm H2O. Secondary outcomes included individual components of the primary outcome, along with other clinical and safety outcomes. Over a 10-year period (Jan 2011-Dec 2020), 175 infants were extubated from mean Paw >9 cm H2O to high CPAP pressures. Twenty-seven patients (median GA = 24.7, [interquartile range (IQR)]: (24.0-26.4) weeks and chronological age = 31, IQR: [21-40] days) were classified into the "higher level CPAP" group while 148 infants (median GA = 25.4, IQR: [24.6-26.6] weeks and chronological age = 26, IQR: [10-39] days) comprised the "equivalent CPAP" group. There was no difference in the primary outcome (44 vs. 51%; p = 0.51), including postadjustment for confounders (adjusted OR [aOR] = 0.47 [95% confidence interval (CI): 0.17-1.29; p = 0.14]). However, reintubation risk within 7 days was lower with higher level CPAP (7 vs. 37%; p < 0.01), including postadjustment (aOR = 0.07; 95% CI: 0.02-0.35; p < 0.01). In this cohort, use of initial distending CPAP pressures 2 to 3 cm H2O higher than preextubation Paw did not alter the primary outcome of failure but did lower the risk of reintubation. The latter is an interesting hypothesis-generating finding that requires further confirmation. · Use of high CPAP pressures (≥9 cm H2O) is gradually increasing in the care of preterm neonates.. · This study compares higher level versus equivalent CPAP in relation to preextubation Paw.. · The findings demonstrate no difference in failure as defined with use of higher level CPAP pressures..

139. DOES POSTOPERATIVE NON-INVASIVE VENTILATION INCREASE THE RISK FOR COMPLICATIONS IN CHILDREN POST-REPAIR OF ESOPHAGEAL ATRESIA?

Abstract The primary aim of this study was to determine if postoperative use of high flow nasal cannula (HFNC) and/or continuous positive airway pressure (CPAP) are independent risk factors for adverse postoperative outcomes after surgical repair of Esophageal Atresia (EA). Secondary aims were to determine other significant clinical risk factors associated with these adverse outcomes. A retrospective chart review was conducted on all EA neonates repaired and managed postoperatively between 2007-2020 across two centres: Sydney Children’s Hospital (SCH) and The Royal Hospital for Women (RHW). The primary outcome measure was anastomotic leakage (AL), and other outcome measures included anastomotic stricture (AS), mediastinitis, sepsis, and pneumothorax. Significant associations were identified using Chi-square, and univariate and multivariate logistical regression models (p &amp;lt; 0.05). We reviewed 104 charts. Post-repair, all were placed on invasive mechanical ventilation (IMV) (median of 119.50 hours). Of these, 45 (43.3%) were subsequently bridged with some form of NIV post-extubation, with 33 each on HFNC and CPAP. 59 (56.7%) developed at least one postoperative complication: 12 had AL, and 17 had AS. After adjustment, no significant association was found between HFNC or CPAP use with development of AL (p = 0.074 and p = 0.859), or any other adverse outcome. Independent risk factors for AL include anastomosis under tension and type B EA. Delayed first oral intake significantly increased risk of mediastinitis and sepsis. Our results show no increased risk of AL or any other adverse postoperative event with use of non-invasive ventilation in form of HFNC and/or CPAP. Reducing anastomotic tension during primary repair of OA-TOF and introducing early oral feeding appears to be protective and reduces risk of AL and infection. However, further prospective research is still needed to help guide post extubation ventilation strategies in this population.

Systematic review and cost-utility of high flow nasal cannula versus continuous positive airway pressure in children with acute severe or moderate bronchiolitis in Colombia.

Nasal Continuous Positive AirwayPressure (CPAP) and High-Flow Nasal Cannula (HFNC) have emerged as alternatives to orotracheal intubation and conventional invasive ventilation in patients with moderate to severe bronchiolitis. This study aims to evaluate the evidence and the cost-utility of HFNC compared to CPAP in infants with moderate-severe bronchiolitis in Colombia. The search includes electronic databases such as Pubmed, ScienceDirect, and Embase. Through inclusion and exclusion criteria, screen randomized controlled trials. A decision tree model was used to estimate the cost-utility of CPAP compared with HFNC in infants with moderate-severe bronchiolitis. Sensitivity analysis of transition probabilities, utilities, and cost was carried out. Incorporate five studies that meet the criteria. The risk of intubation rate in the patients with CPAP is lower than HFNC (relative risk 0.62; 95% confidence interval 0.46-0.84; I2 = 0%) The base-case analysis showed that compared with HFNC, CPAP was associated with lower costs and higher quality-adjusted life years (QALYs). The expected annual cost per patient with CPAP was US$17,574 and with HFNC was US$29,421. The QALYs per person estimated with CPAP were 0.92 and with HFNC was 0.91. This position of absolute dominance of CPAP (CPAP has lower costs and higher QALYs than HFNI) makes it unnecessary to estimate the incremental cost-utility ratio. CPAP is cost-effective, over the HFNC, in infants with severe-moderate bronchiolitis in Colombia. Our study provides evidence that should be used by decision-makers to improve clinical practice guidelines and should be replicated to validate their results in other countries.