Abstract
Objective
To evaluate the efficacy of nasal continuous positive airway pressure (nCPAP) in decreasing respiratory distress in bronchiolitis.
Design
Randomized controlled trial.
Setting
Tertiary-care hospital in New Delhi, India.
Participants
72 infants (age < 1y) hospitalized with a clinical diagnosis of bronchiolitis were randomized to receive standard care, or nCPAP in addition to standard care, in the first hour after admission. 23 parents refused to give consent for participation. 2 infants did not tolerate nCPAP.
Intervention
The outcome was assessed after 60 minutes. If nCPAP was not tolerated or the distress increased, the infant was switched to standard care. Analysis was done on intention-to-treat basis.
Main outcome measures
Change in respiratory rate, Silverman-Anderson score and a Modified Pediatric Society of New Zealand Severity Score.
Results
14 out of 32 in nCPAP group and 5 out of 35 in standard care group had change in respiratory rate ≥10 (P=0.008). The mean (SD) change in respiratory rate[8.0 (5.8) vs 5.1 (4.0), P=0.02] in Silverman-Anderson score [0.78 (0.87) vs 0.39 (0.73), P=0.029] and in Modified Pediatric Society of New Zealand Severity Score [2.5 (3.01) vs. 1.08 (1.3), P=0.012] were significantly different in the nCPAP and standard care groups, respectively.
Conclusion
nCPAP helped reduce respiratory distress significantly compared to standard care.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Ralston SL, Lieberthal AS, Meissner HC, Alverson BK, Baley JE, Gadomski AM, et al. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics. 2014;134:e1474–502.
Oymar K, Skjerven HO, Mikalsen IB. Acute bronchiolitis in infants, a review. Scand J Trauma Resusc Emerg Med. 2014;22:3.
Beasley JM, Jones SE. Continuous positive airway pressure in bronchiolitis. Br Med J (Clin Res Ed). 1981;283:1506–8.
Wilson PT, Morris MC, Biagas KV, Otupiri E, Moresky RT. A randomized clinical trial evaluating nasal continuous positive airway pressure for acute respiratory distress in a developing country. J Pediatr. 2013;162:988–92.
Gregory GA, Kitterman JA, Phibbs RH, Tooley WH, Hamilton WK. Treatment of the idiopathic respiratorydistress syndrome with continuous positive airway pressure. N Engl J Med. 1971;284:1333–40.
Kaur C, Sema A, Beri RS, Puliyel JM. A simple circuit to deliver bubbling CPAP. Indian Pediatr. 2008;45:312–4.
Paediatric Society of New Zealand. 2005. Best Practice Evidenced Based Guidelines. Wheeze and Chest Infection In Infants Under 1 Year. Available from: http://www.paediatrics.org.nz/files/guidelines/Wheezeendorsed. pdf. Accessed February 22, 2017.
Verma N, Lodha R, Kabra SK. Recent advances in management of bronchiolitis. Indian Pediatr. 2013;50:939–49.
Milesi C, Matecki S, Jaber S, Mura T, Jacquot A, Pidoux O, et al. 6 cmH2O continuous positive airway pressure versus conventional oxygen therapy in severe viral bronchiolitis: A randomized trial. Pediatr Pulmonol. 2013;48:45–51.
Thia LP, McKenzie SA, Blyth TP, Minasian CC, Kozlowska WJ, Carr SB. Randomised controlled trial of nasal continuous positive airways pressure (CPAP) in bronchiolitis. Arch Dis Child. 2008;93:45–7.
Machen HE, Mwanza ZV, Brown JK, Kawaza KM, Newberry L, Richards-Kortum RR, et al. Outcomes of patients with respiratory distress treated with bubble CPAP on a pediatric ward in Malawi. J Trop Pediatr. 2015;61:421–7.
Jat KR, Mathew JL. Continuous positive airway pressure (CPAP) for acute bronchiolitis in children. Cochrane Database Syst Rev. 2015;1:CD010473.
Oymar K, Bardsen K. Continuous positive airway pressure for bronchiolitis in a general paediatric ward; a feasibility study. BMC Pediatr. 2014;14:122.
Essouri S, Durand P, Chevret L, Balu L, Devictor D, Fauroux B, et al. Optimal level of nasal continuous positive airway pressure in severe viral bronchiolitis. Intensive Care Med. 2011;37:2002–7.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.
The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.
To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Lal, S.N., Kaur, J., Anthwal, P. et al. Nasal Continuous Positive Airway Pressure in Bronchiolitis: A Randomized Controlled Trial. Indian Pediatr 55, 27–30 (2018). https://doi.org/10.1007/s13312-018-1222-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13312-018-1222-7