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Indian Pediatrics

, Volume 55, Issue 1, pp 27–30 | Cite as

Nasal Continuous Positive Airway Pressure in Bronchiolitis: A Randomized Controlled Trial

  • Sandeep Narayan Lal
  • Jaspreet Kaur
  • Pooja Anthwal
  • Kanika Goyal
  • Pinky Bahl
  • Jacob M. Puliyel
Open Access
Research Paper

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.

Keywords

nCPAP Ventilation Respiratory distress Respiratory Syncytial Virus Wheezing infant 

References

  1. 1.
    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.CrossRefPubMedGoogle Scholar
  2. 2.
    Oymar K, Skjerven HO, Mikalsen IB. Acute bronchiolitis in infants, a review. Scand J Trauma Resusc Emerg Med. 2014;22:3.CrossRefGoogle Scholar
  3. 3.
    Beasley JM, Jones SE. Continuous positive airway pressure in bronchiolitis. Br Med J (Clin Res Ed). 1981;283:1506–8.CrossRefGoogle Scholar
  4. 4.
    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.CrossRefPubMedGoogle Scholar
  5. 5.
    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.CrossRefPubMedGoogle Scholar
  6. 6.
    Kaur C, Sema A, Beri RS, Puliyel JM. A simple circuit to deliver bubbling CPAP. Indian Pediatr. 2008;45:312–4.PubMedGoogle Scholar
  7. 7.
    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.Google Scholar
  8. 8.
    Verma N, Lodha R, Kabra SK. Recent advances in management of bronchiolitis. Indian Pediatr. 2013;50:939–49.CrossRefPubMedGoogle Scholar
  9. 9.
    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.CrossRefPubMedGoogle Scholar
  10. 10.
    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.CrossRefPubMedGoogle Scholar
  11. 11.
    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.PubMedGoogle Scholar
  12. 12.
    Jat KR, Mathew JL. Continuous positive airway pressure (CPAP) for acute bronchiolitis in children. Cochrane Database Syst Rev. 2015;1:CD010473.PubMedGoogle Scholar
  13. 13.
    Oymar K, Bardsen K. Continuous positive airway pressure for bronchiolitis in a general paediatric ward; a feasibility study. BMC Pediatr. 2014;14:122.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    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.CrossRefPubMedGoogle Scholar

Copyright information

© Indian Academy of Pediatrics 2017

Authors and Affiliations

  • Sandeep Narayan Lal
    • 1
  • Jaspreet Kaur
    • 1
  • Pooja Anthwal
    • 1
  • Kanika Goyal
    • 1
  • Pinky Bahl
    • 1
  • Jacob M. Puliyel
    • 1
  1. 1.Department of PediatricsSt. Stephens HospitalTis Hazari, DelhiIndia

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