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Title: | Safety and effectiveness of bubble continuous positive airway pressure as respiratory support for bronchiolitis in a pediatric ward |
Author: | Agüera, Marta Melé Casas, Maria Molina, Maria Mercedes Pons Odena, Martí Fernández de Sevilla Estrach, Mariona García García, Juan José Launes Montaña, Cristian Monfort, Laura |
Keywords: | Urgències en pediatria Pediatria Infeccions respiratòries Bronquis Seguretat dels pacients Pediatric emergencies Pediatrics Respiratory infections Bronchi Patients safety |
Issue Date: | 1-Dec-2022 |
Publisher: | Springer Verlag |
Abstract: | The results of several clinical trials suggest that continuous positive airway pressure (CPAP) for acute bronchiolitis can be more efective than high-fow nasal cannula (HFNC). The use of HFNC involved a minimum reduction (5%) in admissions to the pediatric intensive care unit (PICU) in our hospital. Our main aim was to evaluate its safety and efectiveness as respiratory support for patients with bronchiolitis in a pediatric general ward. A secondary goal was to compare the admissions to PICU and the invasive mechanical ventilation (IMV) rate of patients treated with HFNC and those treated with HFNC/b-CPAP during the 2018–2019 and 2019–2020 epidemic seasons, respectively. Two prospective single-centre observational studies were performed. For the main aim, a cohort study (CS1) was carried out from 1st of November 2019 to 15th of January 2020. Inclusion criteria were children aged up to 3 months with bronchiolitis treated with b-CPAP support when HFNC failed. Epidemiological and clinical parameters were collected before and 60 min after the onset of CPAP and compared between the responder (R) and non-responders (NR) groups. NR was the group that required PICU admission. One hundred ffty-eight patients were admitted to the ward with bronchiolitis and HFNC. Fifty-seven out of one hundred ffty-eight required b-CPAP. No adverse events were observed. Thirty-two out of ffty-seven remained in the general ward (R-group), and 25/57 were admitted to PICU (NR-group). There were statistically signifcant diferences in respiratory rate (RR) and heart rate (HR) between both groups before and after the initiation of b-CPAP, but the multivariable models showed that the main diferences were observed after 60 min of therapy (lower HR, RR, BROSJOD score and FiO2 in the R-group). For the secondary aim, another cohort study (CS2) was performed comparing data from a pre-b-CPAP bronchiolitis season (1st of November 2018 to 15th January 2019) and the b-CPAP season (2019–2020). Inclusion criteria in pre-b-CPAP season were children aged up to 3 months admitted to the same general ward with moderate-severe bronchiolitis and with HFNC support. Admissions to PICU during the CPAP season were signifcantly reduced, without entailing an increase in the rate of IMV. Conclusion: The implementation of b-CPAP for patients with bronchiolitis in a pediatric ward, in whom HFNC fails, is safe and efective and results in a reduction in PICU admissions. |
Note: | Reproducció del document publicat a: https://doi.org/10.1007/s00431-022-04616-3 |
It is part of: | European Journal of Pediatrics, 2022, vol. 181, num.12, p. 4039-4047 |
URI: | http://hdl.handle.net/2445/214080 |
Related resource: | https://doi.org/10.1007/s00431-022-04616-3 |
ISSN: | 0340-6199 |
Appears in Collections: | Articles publicats en revistes (Cirurgia i Especialitats Medicoquirúrgiques) |
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