Signe Vahlkvist1,2, Louise Jürgensen3, Amalie la Cour4, Simone Markoew4, Thomas Houmann Petersen3, Poul-Erik Kofoed3. 1. Department of Pediatric and Adolecent Medicine, Hospital South West Jutland, Finsensgade 35, Esbjerg, 6700, Denmark. Signe.Vahlkvist@rsyd.dk. 2. Department of Paediatrics and Adolescent Medicine, Hospital of Lillebaelt, Sygehusvej 24, Kolding, 6000, Denmark. Signe.Vahlkvist@rsyd.dk. 3. Department of Paediatrics and Adolescent Medicine, Hospital of Lillebaelt, Sygehusvej 24, Kolding, 6000, Denmark. 4. Department of Pediatric and Adolecent Medicine, Hospital South West Jutland, Finsensgade 35, Esbjerg, 6700, Denmark.
Abstract
Continuous positive airway pressure (CPAP) has been used in infants with bronchiolitis for decades. Recently, high flow nasal cannula (HFNC) therapy was introduced. We conducted a trial of 50 children with bronchiolitis who were randomized to treatment with CPAP or HFNC. Objectives were to compare the development in respiratory rate, pCO2, and Modified Woods Clinical Asthma Score (M-WCAS) in young children with bronchiolitis, treated with CPAP or HFNC. Secondarily, to compare Neonatal Infant Pain Score (NIPS), treatment duration, treatment failure, and hospitalization length. Median age at inclusion was 2.8 (CPAP group) vs 2.1 months (HFNC group). Mean baseline pCO2 was 6.7 in both groups and mean respiratory rate was 60 vs 56 in the CPAP and HFNC group respectively. No differences were observed in development of respiratory rate, pCO2, or M-WCAS. NIPS was higher in the CPAP group. Treatment failure was scarce in both groups. No significant differences in treatment duration or length of hospitalization were observed. Conclusion: In infants and young children with bronchiolitis, HFNC may be an effective and pleasant alternative to CPAP. Larger multicenter studies are needed to further explore differences in treatment failure and treatment duration.Trial registration: www.clinicaltrial.gov. id NCT02618213, registration date December 1, 2015.What is Known:• CPAP has been used for many years for respiratory support in infant bronchiolitis. The method requires special staff skills and may be stressful to the child.• HFNC has been introduced as a newer tool.What is New:• In infants with bronchiolitis, HFNC and CPAP were comparable in decreasing respiratory rate, pCO2, and need for oxygen supply.• Pain score during therapy was lower in the HFNC group.
RCT Entities:
Continuous positive airway pressure (CPAP) has been used in infants with bronchiolitis for decades. Recently, high flow nasal cannula (HFNC) therapy was introduced. We conducted a trial of 50 children with bronchiolitis who were randomized to treatment with CPAP or HFNC. Objectives were to compare the development in respiratory rate, pCO2, and Modified Woods Clinical Asthma Score (M-WCAS) in young children with bronchiolitis, treated with CPAP or HFNC. Secondarily, to compare Neonatal InfantPain Score (NIPS), treatment duration, treatment failure, and hospitalization length. Median age at inclusion was 2.8 (CPAP group) vs 2.1 months (HFNC group). Mean baseline pCO2 was 6.7 in both groups and mean respiratory rate was 60 vs 56 in the CPAP and HFNC group respectively. No differences were observed in development of respiratory rate, pCO2, or M-WCAS. NIPS was higher in the CPAP group. Treatment failure was scarce in both groups. No significant differences in treatment duration or length of hospitalization were observed. Conclusion: In infants and young children with bronchiolitis, HFNC may be an effective and pleasant alternative to CPAP. Larger multicenter studies are needed to further explore differences in treatment failure and treatment duration.Trial registration: www.clinicaltrial.gov. id NCT02618213, registration date December 1, 2015.What is Known:• CPAP has been used for many years for respiratory support in infantbronchiolitis. The method requires special staff skills and may be stressful to the child.• HFNC has been introduced as a newer tool.What is New:• In infants with bronchiolitis, HFNC and CPAP were comparable in decreasing respiratory rate, pCO2, and need for oxygen supply.• Pain score during therapy was lower in the HFNC group.
Authors: Padmanabhan Ramnarayan; Alvin Richards-Belle; Laura Drikite; Michelle Saull; Izabella Orzechowska; Robert Darnell; Zia Sadique; Julie Lester; Kevin P Morris; Lyvonne N Tume; Peter J Davis; Mark J Peters; Richard G Feltbower; Richard Grieve; Karen Thomas; Paul R Mouncey; David A Harrison; Kathryn M Rowan Journal: JAMA Date: 2022-07-12 Impact factor: 157.335