Giovanna Chidini1, Marco Piastra2, Tiziana Marchesi3, Daniele De Luca2, Luisa Napolitano4, Ida Salvo5, Andrea Wolfler5, Paolo Pelosi6, Mirco Damasco3, Giorgio Conti2, Edoardo Calderini4. 1. Pediatric ICU, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; giovannachid@libero.it. 2. Pediatric ICU, Department of Anaesthesiology and Intensive Care, University Hospital "A. Gemelli," Catholic University of the Sacred Heart, Rome, Italy; 3. University of Milan, Milan, Italy; 4. Pediatric ICU, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; 5. Department of Anesthesia and Intensive Care, Children's Hospital Vittore Buzzi, Istituti Clinici di Perfezionamento, Milan, Italy; and. 6. Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, IRCCS AOU San Martino - IST, Genoa, Italy.
Abstract
BACKGROUND:Noninvasive continuous positive airway pressure (CPAP) is usually applied with a nasal or facial mask to treat mild acute respiratory failure (ARF) in infants. A pediatric helmet has now been introduced in clinical practice to deliver CPAP. This study compared treatment failure rates during CPAP delivered by helmet or facial mask in infants with respiratory syncytial virus-induced ARF. METHODS: In this multicenter randomized controlled trial, 30 infants with respiratory syncytial virus-induced ARF were randomized to receive CPAP by helmet (n = 17) or facial mask (n = 13). The primary endpoint was treatment failure rate (defined as due to intolerance or need for intubation). Secondary outcomes were CPAP application time, number of patients requiring sedation, and complications with each interface. RESULTS: Compared with the facial mask, CPAP by helmet had a lower treatment failure rate due to intolerance (3/17 [17%] vs 7/13 [54%], P = .009), and fewer infants required sedation (6/17 [35%] vs 13/13 [100%], P = .023); the intubation rates were similar. In successfully treated patients, CPAP resulted in better gas exchange and breathing pattern with both interfaces. No major complications due to the interfaces occurred, but CPAP by mask had higher rates of cutaneous sores and leaks. CONCLUSIONS: These findings confirm that CPAP delivered by helmet is better tolerated than CPAP delivered by facial mask and requires less sedation. In addition, it is safe to use and free from adverse events, even in a prolonged clinical setting.
RCT Entities:
BACKGROUND: Noninvasive continuous positive airway pressure (CPAP) is usually applied with a nasal or facial mask to treat mild acute respiratory failure (ARF) in infants. A pediatric helmet has now been introduced in clinical practice to deliver CPAP. This study compared treatment failure rates during CPAP delivered by helmet or facial mask in infants with respiratory syncytial virus-induced ARF. METHODS: In this multicenter randomized controlled trial, 30 infants with respiratory syncytial virus-induced ARF were randomized to receive CPAP by helmet (n = 17) or facial mask (n = 13). The primary endpoint was treatment failure rate (defined as due to intolerance or need for intubation). Secondary outcomes were CPAP application time, number of patients requiring sedation, and complications with each interface. RESULTS: Compared with the facial mask, CPAP by helmet had a lower treatment failure rate due to intolerance (3/17 [17%] vs 7/13 [54%], P = .009), and fewer infants required sedation (6/17 [35%] vs 13/13 [100%], P = .023); the intubation rates were similar. In successfully treated patients, CPAP resulted in better gas exchange and breathing pattern with both interfaces. No major complications due to the interfaces occurred, but CPAP by mask had higher rates of cutaneous sores and leaks. CONCLUSIONS: These findings confirm that CPAP delivered by helmet is better tolerated than CPAP delivered by facial mask and requires less sedation. In addition, it is safe to use and free from adverse events, even in a prolonged clinical setting.
Authors: Holger J Schünemann; Joanne Khabsa; Karla Solo; Assem M Khamis; Romina Brignardello-Petersen; Amena El-Harakeh; Andrea Darzi; Anisa Hajizadeh; Antonio Bognanni; Anna Bak; Ariel Izcovich; Carlos A Cuello-Garcia; Chen Chen; Ewa Borowiack; Fatimah Chamseddine; Finn Schünemann; Gian Paolo Morgano; Giovanna E U Muti-Schünemann; Guang Chen; Hong Zhao; Ignacio Neumann; Jan Brozek; Joel Schmidt; Layal Hneiny; Leila Harrison; Marge Reinap; Mats Junek; Nancy Santesso; Rayane El-Khoury; Rebecca Thomas; Robby Nieuwlaat; Rosa Stalteri; Sally Yaacoub; Tamara Lotfi; Tejan Baldeh; Thomas Piggott; Yuan Zhang; Zahra Saad; Bram Rochwerg; Dan Perri; Eddy Fan; Florian Stehling; Imad Bou Akl; Mark Loeb; Paul Garner; Stephen Aston; Waleed Alhazzani; Wojciech Szczeklik; Derek K Chu; Elie A Akl Journal: Ann Intern Med Date: 2020-05-22 Impact factor: 25.391
Authors: Jens T F Osterkamp; Rune B Strandby; Lara Henningsen; Klaus V Marcussen; Thordis Thomsen; Christian R Mortensen; Michael P Achiam; Øivind Jans Journal: J Clin Monit Comput Date: 2022-04-16 Impact factor: 2.502