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Si us plau utilitzeu sempre aquest identificador per citar o enllaçar aquest document: https://hdl.handle.net/2445/214080
Safety and effectiveness of bubble continuous positive airway pressure as respiratory support for bronchiolitis in a pediatric ward
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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.
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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. Safety and effectiveness of bubble continuous positive airway pressure as respiratory support for bronchiolitis in a pediatric ward. _European Journal of Pediatrics_. 2022. Vol. 181, núm. 12, pàgs. 4039-4047. [consulta: 20 de gener de 2026]. ISSN: 0340-6199. [Disponible a: https://hdl.handle.net/2445/214080]