High-Flow Nasal Cannula versus Continuous Positive Airway Pressure in Critical Bronchiolitis: A Randomized Controlled Pilot

Abstract

We conducted a randomized controlled pilot study in infants with critical bronchiolitis (n = 63) comparing high-flow nasal cannula (HFNC, n = 35) to continuous positive airway pressure (CPAP, n = 28). The primary outcome was treatment failure, defined as the need for bilevel positive pressure ventilation or endotracheal intubation. Treatment failure occurred in 10 patients (35.7%) in the CPAP group and 13 patients (37.1%) in the HFNC group (p = 0.88). Pediatric intensive care unit length of stay was similar between the CPAP and HFNC groups (5 [4–7] days and 5 [4–8] days, p = 0.46, respectively). In this pilot study, treatment with HFNC resulted in a rate of treatment failure similar to CPAP.

Keywords

bronchiolitis - high-flow nasal cannula - continuous positive airway pressure - respiratory syncytial virus - acute respiratory failure - infants

Publikationsverlauf

Eingereicht: 03. Februar 2020

Angenommen: 10. März 2020

Artikel online veröffentlicht:
17. April 2020

• References

• 1 Hall CB, Weinberg GA, Iwane MK. et al. The burden of respiratory syncytial virus infection in young children. N Engl J Med 2009; 360 (06) 588-598
• 2 Meissner HC. Viral bronchiolitis in children. N Engl J Med 2016; 374 (01) 62-72
• 3 Zorc JJ, Hall CB. Bronchiolitis: recent evidence on diagnosis and management. Pediatrics 2010; 125 (02) 342-349
• 4 Øymar K, Skjerven HO, Mikalsen IB. Acute bronchiolitis in infants, a review. Scand J Trauma Resusc Emerg Med 2014; 22: 23
• 5 Martin AJ, Gardner PS, McQuillin J. Epidemiology of respiratory viral infection among paediatric inpatients over a six-year period in north-east England. Lancet 1978; 2 (8098): 1035-1038
• 6 Everard ML. Acute bronchiolitis and croup. Pediatr Clin North Am 2009; 56 (01) 119-133
• 7 Centers for Disease Control and Prevention (CDC). Respiratory syncytial virus activity - United States, July 2008-December 2009. MMWR Morb Mortal Wkly Rep 2010; 59 (08) 230-233
• 8 Glezen WP, Taber LH, Frank AL, Kasel JA. Risk of primary infection and reinfection with respiratory syncytial virus. Am J Dis Child 1986; 140 (06) 543-546
• 9 Gupta P, Beam BW, Rettiganti M. Temporal trends of respiratory syncytial virus-associated hospital and ICU admissions across the United States. Pediatr Crit Care Med 2016; 17 (08) e343-e351
• 10 Slain KN, Shein SL, Stormorken AG, Broberg MCG, Rotta AT. Outcomes of children with critical bronchiolitis living in poor communities. Clin Pediatr (Phila) 2018; 57 (09) 1027-1032
• 11 Slain KN, Rotta AT, Martinez-Schlurmann N, Stormorken AG, Shein SL. Outcomes of children with critical bronchiolitis meeting at risk for pediatric acute respiratory distress syndrome criteria. Pediatr Crit Care Med 2019; 20 (02) e70-e76
• 12 Ralston SL, Lieberthal AS, Meissner HC. et al; American Academy of Pediatrics. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics 2014; 134 (05) e1474-e1502
• 13 Cambonie G, Milési C, Jaber S. et al. Nasal continuous positive airway pressure decreases respiratory muscles overload in young infants with severe acute viral bronchiolitis. Intensive Care Med 2008; 34 (10) 1865-1872
• 14 Essouri S, Durand P, Chevret L. et al. Optimal level of nasal continuous positive airway pressure in severe viral bronchiolitis. Intensive Care Med 2011; 37 (12) 2002-2007
• 15 Milési C, Matecki S, Jaber S. et al. 6 cmH2O continuous positive airway pressure versus conventional oxygen therapy in severe viral bronchiolitis: a randomized trial. Pediatr Pulmonol 2013; 48 (01) 45-51
• 16 Essouri S, Laurent M, Chevret L. et al. Improved clinical and economic outcomes in severe bronchiolitis with pre-emptive nCPAP ventilatory strategy. Intensive Care Med 2014; 40 (01) 84-91
• 17 Milési C, Essouri S, Pouyau R. et al; Groupe Francophone de Réanimation et d'Urgences Pédiatriques (GFRUP). High flow nasal cannula (HFNC) versus nasal continuous positive airway pressure (nCPAP) for the initial respiratory management of acute viral bronchiolitis in young infants: a multicenter randomized controlled trial (TRAMONTANE study). Intensive Care Med 2017; 43 (02) 209-216
• 18 Lee JH, Rehder KJ, Williford L, Cheifetz IM, Turner DA. Use of high flow nasal cannula in critically ill infants, children, and adults: a critical review of the literature. Intensive Care Med 2013; 39 (02) 247-257
• 19 McKiernan C, Chua LC, Visintainer PF, Allen H. High flow nasal cannulae therapy in infants with bronchiolitis. J Pediatr 2010; 156 (04) 634-638
• 20 Schibler A, Pham TM, Dunster KR. et al. Reduced intubation rates for infants after introduction of high-flow nasal prong oxygen delivery. Intensive Care Med 2011; 37 (05) 847-852
• 21 Schlapbach LJ, Straney L, Gelbart B. et al; Australian & New Zealand Intensive Care Society (ANZICS) Centre for Outcomes & Resource Evaluation (CORE) and the Australian & New Zealand Intensive Care Society (ANZICS) Paediatric Study Group. Burden of disease and change in practice in critically ill infants with bronchiolitis. Eur Respir J 2017; 49 (06) 1601648
• 22 Kepreotes E, Whitehead B, Attia J. et al. High-flow warm humidified oxygen versus standard low-flow nasal cannula oxygen for moderate bronchiolitis (HFWHO RCT): an open, phase 4, randomised controlled trial. Lancet 2017; 389 (10072): 930-939
• 23 Clayton JA, McKee B, Slain KN, Rotta AT, Shein SL. Outcomes of children with bronchiolitis treated with high-flow nasal cannula or noninvasive positive pressure ventilation. Pediatr Crit Care Med 2019; 20 (02) 128-135
• 24 Nair H, Nokes DJ, Gessner BD. et al. Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis. Lancet 2010; 375 (9725): 1545-1555
• 25 Ferrés Mataró J, Mangues Bafalluy MA, Farré Riba R, Juliá Brugues A, Bonal de Falgas J. [Subcutaneous adrenaline versus inhaled salbutamol in the treatment of childhood asthmatic crisis]. An Esp Pediatr 1987; 27 (01) 37-40
• 26 Slater A, Shann F, Pearson G. Paediatric Index of Mortality (PIM) Study Group. PIM2: a revised version of the Paediatric Index of Mortality. Intensive Care Med 2003; 29 (02) 278-285
• 27 Tibby SM, Taylor D, Festa M. et al. A comparison of three scoring systems for mortality risk among retrieved intensive care patients. Arch Dis Child 2002; 87 (05) 421-425
• 28 Modesto I Alapont V, Pons-Òdena M, Medina A. High-flow nasal cannula versus noninvasive ventilation: a matter of confusion. Pediatr Crit Care Med 2019; 20 (12) 1210-1211
• 29 Sarkar M, Sinha R, Roychowdhoury S. et al. Comparative study between noninvasive continuous positive airway pressure and hot humidified high-flow nasal cannulae as a mode of respiratory support in infants with acute bronchiolitis in pediatric intensive care unit of a tertiary care hospital. Indian J Crit Care Med 2018; 22 (02) 85-90
• 30 Weiler T, Kamerkar A, Hotz J, Ross PA, Newth CJL, Khemani RG. The Relationship between high flow nasal cannula flow rate and effort of breathing in children. J Pediatr 2017; 189: 66-71.e3
• 31 Milési C, Pierre AF, Deho A. et al; GFRUP Respiratory Study Group. A multicenter randomized controlled trial of a 3-L/kg/min versus 2-L/kg/min high-flow nasal cannula flow rate in young infants with severe viral bronchiolitis (TRAMONTANE 2). Intensive Care Med 2018; 44 (11) 1870-1878
• 32 Franklin D, Babl FE, Schlapbach LJ. et al. A randomized trial of high-flow oxygen therapy in infants with bronchiolitis. N Engl J Med 2018; 378 (12) 1121-1131
• 33 Lin J, Zhang Y, Xiong L, Liu S, Gong C, Dai J. High-flow nasal cannula therapy for children with bronchiolitis: a systematic review and meta-analysis. Arch Dis Child 2019; 104 (06) 564-576