Facultade de Fisioterapia

Helmet Versus Nasal-Prong CPAP in Infants With Acute Bronchiolitis

Mayordomo-Colunga, Juan; Rey, Corsino; Medina, Alberto; Martínez Camblor, Pablo; Vivanco-Allende, Ana; Concha, Andres
Abstract:
BACKGROUND: Nasal prongs are frequently used to deliver noninvasive CPAP in bronchiolitis, especially in the youngest children. A helmet interface is an alternative that might be comparable to nasal prongs. We sought to compare these interfaces. METHODS: We performed a prospective, randomized, crossover, single-center study in an 8-bed multidisciplinary pediatric ICU in a university hospital. Infants age < 3 months who were consecutively admitted to the pediatric ICU during a bronchiolitis epidemic season and fulfilled inclusion criteria were recruited. Subjects were randomly allocated to receive CPAP via a helmet or nasal prongs for 60 min. The subjects were then placed on the other CPAP system for another 60-min period (helmet then nasal prongs [H-NP] or nasal prongs then helmet [NP-H]). Measurements were taken at 30, 60, 90, and 120 min. Failure was defined as the need for further respiratory support. RESULTS: Sixteen subjects were included, with 9 in the H-NP group and 7 in the NP-H group. CPAP significantly reduced respiratory distress, showing no differences between the H-NP and NP-H groups in terms of improving the Modified Wood's Clinical Asthma Score from 4.8 +/- 1 to 3 +/- 0.9 and 2.7 +/- 1.7 points at 60 min and 120 min in the H-NP group, respectively, and from 4.2 +/- 0.9 to 2.8 +/- 0.9 and to 2.9 +/- 0.9 at 60 min and 120 min, respectively, in the NP-H group. Sedatives were used in only 3 subjects (2 in the NP-H group, P = .77). The failure rate was similar in both groups (3 of 9 subjects vs 3 of 7 subjects, P = .70). No significant differences were seen for heart rate, breathing frequency, F-IO2, or transcutaneous oxygen saturation response. CONCLUSIONS: Our results suggest that CPAP delivered by nasal prongs and CPAP delivered by helmet are similar in terms of efficacy in young infants with acute bronchiolitis. (c) 2018 Daedalus Enterprises
Year:
2018
Type of Publication:
Article
Keywords:
bronchiolitis; continuous positive airway pressure; noninvasive ventilation; helmet; nasal prongs; infants
Journal:
Respiratory Care
Volume:
63
Number:
4
Pages:
455-463
Month:
April
Note:
Q3 h-index 2,073 (JCR2017)
DOI:
10.4187/respcare.05840
Hits: 1648