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Emami Zeydi A, Zare‐Kaseb A, Nazari AM, Ghazanfari MJ, Sarmadi S. Mask-related pressure injury prevention associated with non-invasive ventilation: A systematic review. Int Wound J 2024; 21:e14909. [PMID: 38826030 PMCID: PMC11144948 DOI: 10.1111/iwj.14909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 06/04/2024] Open
Abstract
Noninvasive ventilation interfaces are one of the main factors contributing to pressure injuries caused by medical devices. Prevention is still the best course of action when discussing noninvasive ventilation-induced pressure injuries. A systematic review was designed to summarize and analyse all published literature on strategies to prevent pressure injuries caused by masks in patients undergoing noninvasive ventilation. The protocol of the systematic review followed the PRISMA guideline. An extensive search from the beginning to May 16, 2023, using current articles in databases such as Web of Science (WOS), Scopus, PubMed, and Cochrane Library was conducted. Medical Subject Headings (MESH) were used as follows: "Pressure Injury," "Noninvasive Ventilation," "Prevention," and "Pressure Sore." Any language-published studies that met the inclusion criteria were included in this review. A risk of bias assessment was conducted using the Joanna Briggs Institute tool, including evaluation methodologies for all studies. Database searches yielded 2546 articles, which were reduced to 23 that met our criteria after reviewing full texts. A narrative synthesis was conducted. As a result, type of interface (14 studies), dressings (4 studies), adjustment of mask leakage (1 study), humidity (1 study), positioning (1 study), and design of personalized masks (2 studies) seem to be a practical approach to prevent pressure injuries caused by masks in patients undergoing noninvasive ventilation. The results of our study show the effectiveness of preventive methods in reducing the incidence of pressure injuries caused by masks. Given the significant occurrence of pressure injury related to noninvasive ventilation and the crucial role of prevention and treatment, it is imperative to conduct more rigorous studies to ascertain the efficacy of each strategy.
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Affiliation(s)
- Amir Emami Zeydi
- Department of Medical‐Surgical Nursing, Nasibeh School of Nursing and MidwiferyMazandaran University of Medical SciencesSariIran
| | - Akbar Zare‐Kaseb
- Nursing and Midwifery SchoolShahid Beheshti University of Medical SciencesTehranIran
| | - Amir Mohamad Nazari
- Nursing and Midwifery SchoolShahid Beheshti University of Medical SciencesTehranIran
| | - Mohammad Javad Ghazanfari
- Department of Medical‐Surgical Nursing, School of Nursing and MidwiferyShahid Beheshti University of Medical SciencesTehranIran
| | - Sogand Sarmadi
- Nursing and Midwifery SchoolShahid Beheshti University of Medical SciencesTehranIran
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Yang T, Ma Y, Chen X, Yang Q, Pei J, Zhang Z, Qian X, Wang Y, Fan X, Han L. Effect of different noninvasive ventilation interfaces on the prevention of facial pressure injury: A network meta-analysis. Intensive Crit Care Nurs 2024; 81:103585. [PMID: 37977002 DOI: 10.1016/j.iccn.2023.103585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/28/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE To assess the effect of different noninvasive ventilation interfaces on preventing the facial pressure injury. METHODS This network meta-analysis was conducted following the PRISMA reporting guidelines. Seven electronic databases were systematically searched for randomised controlled trials about the comparative effectiveness of different interfaces in preventing facial pressure injury with noninvasive ventilation in adults and newborns from inception to June 2023. The acronym of PICOS was used and the keywords as well as inclusion/exclusion criteria were determined. Study selection and data extraction were performed by two independent reviewers. The Cochrane risk of bias assessment tool was used to assess the methodological quality. RESULTS A total of 78 randomised controlled trials involving 7,291 patients were included. The results of network meta-analysis showed that the effectiveness of the eight noninvasive ventilation interfaces on the prevention of facial pressure injury was in the order of: nasal cannula > full-face mask > rotation of nasal mask with nasal prongs > helmet > nasal mask > oronasal mask > nasal prongs > face mask. The use of full-face mask in adults and nasal cannula in newborns had the best effect on preventing the incidence of facial pressure injury. CONCLUSIONS The use of full-face mask in adults and nasal cannula in newborns had the most clinical advantage in preventing the incidence of facial pressure injury and were worthy promoting in clinical practice. IMPLICATIONS FOR CLINICAL PRACTICE This study provides a certain theoretical basis for the selection of appropriate interface for patients with noninvasive ventilation. Clinical practitioners should choose the appropriate interfaces based on the patient's specific condition to reduce the incidence of facial pressure injury, enhance patient comfort, and improve the effectiveness of respiratory therapy.
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Affiliation(s)
- Tingting Yang
- Evidence-based Nursing Center, School of Nursing, School of First Clinical Medical, Lanzhou University, Lanzhou, Gansu, China
| | - Yuxia Ma
- Evidence-based Nursing Center, School of Nursing, School of First Clinical Medical, Lanzhou University, Lanzhou, Gansu, China
| | - Xiaoli Chen
- Department of Pediatrics, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Qiuxia Yang
- School of First Clinical Medical, Lanzhou University, Lanzhou, Gansu, China
| | - Juhong Pei
- School of First Clinical Medical, Lanzhou University, Lanzhou, Gansu, China
| | - Ziyao Zhang
- School of Foreign Languages, Lanzhou University of Arts and Science, Lanzhou, Gansu, China
| | - Xiaoling Qian
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Yunyun Wang
- Gansu Provincial Maternity and Child Care Hospital, Lanzhou, Gansu, China
| | - Xiangping Fan
- Department of Nursing, The Third People's Hospital of Lanzhou, Lanzhou, Gansu, China
| | - Lin Han
- Department of Nursing, Gansu Provincial Hospital, Lanzhou, Gansu, China.
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De Luca D, Pezza L, Vivalda L, Di Nardo M, Lepainteur M, Baraldi E, Piastra M, Ricciardi W, Conti G, Gualano MR. Critical care of severe bronchiolitis during shortage of ICU resources. EClinicalMedicine 2024; 69:102450. [PMID: 38333363 PMCID: PMC10850123 DOI: 10.1016/j.eclinm.2024.102450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 02/10/2024] Open
Abstract
Large seasonal outbreaks of bronchiolitis put pressure on healthcare systems and particularly on intensive care units (ICUs). ICU admission is necessary to provide respiratory support to the severest cases, otherwise bronchiolitis can result in substantial mortality. ICU resources are often insufficient and there is scant evidence to guide the ICU clinical management. Most available studies do not cover the ICU-admitted cases and do not consider the associated public health issues. We review this topic through a multidisciplinary approach from both the clinical and public health perspectives, with an analysis based on pathophysiology and cost-effectiveness. We suggest ways to optimise respiratory care, minimise ICU stay, "protect" ICU beds and, whenever possible, make them available for other critically ill children. We also provide guidance on how to prepare ICUs to work under stressful conditions due to outbreaks and to reduce the risk of nosocomial cross-contamination, particularly in ICUs caring for high-risk children. Funding None.
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Affiliation(s)
- Daniele De Luca
- Division of Paediatrics and Neonatal Critical Care, “A. Béclère” Hospital, APHP-Paris Saclay University, Paris, France
- Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris Saclay University, Paris, France
| | - Lucilla Pezza
- Division of Paediatrics and Neonatal Critical Care, “A. Béclère” Hospital, APHP-Paris Saclay University, Paris, France
| | - Laura Vivalda
- Division of Paediatrics and Neonatal Critical Care, “A. Béclère” Hospital, APHP-Paris Saclay University, Paris, France
| | - Matteo Di Nardo
- Paediatric Intensive Care Unit, “Bambino Gesù” Children's Hospital-IRCCS, Rome, Italy
| | - Margaux Lepainteur
- Division of Bacteriology-Hygiene, “A. Béclère” Hospital, APHP-Paris Saclay University, Paris, France
| | - Eugenio Baraldi
- Neonatal Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padova, Padua, Italy
- Respiratory Syncytial Virus Network (RESVINET) Foundation, Zeist, the Netherlands
| | - Marco Piastra
- Paediatric Intensive Care Unit, “A. Gemelli” University Hospital Foundation-IRCCS, Rome, Italy
- Department of Biotechnological Sciences, Intensive and Perioperative Medicine, Catholic University of Sacred Heart, Rome, Italy
| | - Walter Ricciardi
- Leadership Research Centre, Catholic University of Sacred Heart, Rome, Italy
| | - Giorgio Conti
- Paediatric Intensive Care Unit, “A. Gemelli” University Hospital Foundation-IRCCS, Rome, Italy
- Department of Biotechnological Sciences, Intensive and Perioperative Medicine, Catholic University of Sacred Heart, Rome, Italy
| | - Maria Rosaria Gualano
- UniCamillus - Saint Camillus International University of Health and Medical Sciences, Rome, Italy
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4
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Osterkamp JTF, Strandby RB, Henningsen L, Marcussen KV, Thomsen T, Mortensen CR, Achiam MP, Jans Ø. Comparing the effects of continuous positive airway pressure via mask or helmet interface on oxygenation and pulmonary complications after major abdominal surgery: a randomized trial. J Clin Monit Comput 2023; 37:63-70. [PMID: 35429325 PMCID: PMC9013185 DOI: 10.1007/s10877-022-00857-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/29/2022] [Indexed: 01/25/2023]
Abstract
The risk of pulmonary complications is high after major abdominal surgery but may be reduced by prophylactic postoperative noninvasive ventilation using continuous positive airway pressure (CPAP). This study compared the effects of intermittent mask CPAP (ICPAP) and continuous helmet CPAP (HCPAP) on oxygenation and the risk of pulmonary complications following major abdominal surgery. Patients undergoing open abdominal aortic aneurysm repair or pancreaticoduodenectomy were randomized (1:1) to either postoperative ICPAP or HCPAP. Oxygenation was evaluated as the partial pressure of oxygen in arterial blood fraction of inspired oxygen ratio (PaO2/FIO2) at 6 h, 12 h, and 18 h postoperatively. Pulmonary complications were defined as X-ray verified pneumonia/atelectasis, clinical signs of pneumonia, or supplementary oxygen beyond postoperative day 3. Patient-reported comfort during CPAP treatment was also evaluated. In total, 96 patients (ICPAP, n = 48; HCPAP, n = 48) were included, and the type of surgical procedure were evenly distributed between the groups. Oxygenation did not differ between the groups by 6 h, 12 h, or 18 h postoperatively (p = 0.1, 0.08, and 0.67, respectively). Nor was there any difference in X-ray verified pneumonia/atelectasis (p = 0.40) or supplementary oxygen beyond postoperative day 3 (p = 0.53). Clinical signs of pneumonia tended to be more frequent in the ICPAP group (p = 0.06), yet the difference was not statistically significant. Comfort scores were similar in both groups (p = 0.43), although a sensation of claustrophobia during treatment was only experienced in the HCPAP group (11% vs. 0%, p = 0.03). Compared with ICPAP, using HCPAP was associated with similar oxygenation (i.e., PaO2/FIO2 ratio) and a similar risk of pulmonary complications. However, HCPAP treatment was associated with a higher sensation of claustrophobia.
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Affiliation(s)
- Jens T F Osterkamp
- Department of Surgical Gastroenterology, Centre for Cancer and Organ Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Rune B Strandby
- Department of Surgical Gastroenterology, Centre for Cancer and Organ Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lara Henningsen
- Department of Anaesthesia, Centre for Cancer and Organ Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Klaus V Marcussen
- Department of Anaesthesia and Intensive Care, Slagelse Hospital, University of Zeeland, Slagelse, Denmark
| | - Thordis Thomsen
- Department of Clinical Medicine, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Christian R Mortensen
- Department of Anaesthesia, Centre for Cancer and Organ Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Michael P Achiam
- Department of Surgical Gastroenterology, Centre for Cancer and Organ Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Øivind Jans
- Department of Anaesthesia, Centre for Cancer and Organ Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Smith ME, Gray M, Wilson PT. Acceptance and Tolerability of Helmet CPAP in Pediatric Bronchiolitis and Pneumonia: A Feasibility Study. J Pediatr Intensive Care 2023. [DOI: 10.1055/s-0042-1760634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
AbstractContinuous positive airway pressure (CPAP) is a form of non-invasive ventilation used to support pediatric patients with acute respiratory infections. Traditional CPAP interfaces have been associated with inadequate seal, mucocutaneous injury, and aerosolization of infectious particles. The helmet interface may be advantageous given its ability to create a complete seal, avoid skin breakdown, and decrease aerosolization of viruses. We aim to measure tolerability and safety in a pediatric population in the United States and ascertain feedback from parents and health care providers. We performed a prospective, open-label, single-armed feasibility study to assess tolerability and safety of helmet CPAP. Pediatric patients 1 month to 5 years of age admitted to the pediatric intensive care unit with pulmonary infections who were on CPAP for at least 2 hours were eligible. The primary outcome was percentage of patients tolerating helmet CPAP for 4 hours. Secondary measures included the rate of adverse events and change in vital signs. Qualitative feedback was obtained from families, nurses, and respiratory therapists. Five patients were enrolled and 100% tolerated helmet CPAP the full 4-hour study period. No adverse events or significant vital sign changes were observed. All family members preferred to continue the helmet interface, nursing staff noted it made cares easier, and respiratory therapists felt the set up was easy. Helmet CPAP in pediatric patients is well-tolerated, safe, and accepted by medical staff and families in the United States future randomized controlled trials measuring its effectiveness compared with traditional CPAP interfaces are needed.
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Affiliation(s)
- Michele E. Smith
- Division of Pediatric Critical Care, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, University of Rochester Medical Center Golisano Children's Hospital, Rochester, New York, United States
| | - Meghan Gray
- Division of Critical Care and Hospital Medicine, Department of Pediatrics, Columbia University Irving Medical Center, New York Presbyterian Morgan Stanley Children's Hospital, New York, New York, United States
| | - Patrick T. Wilson
- Division of Pediatric Critical Care, Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital of Colorado, Aurora, Colorado, United States
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Milési C, Baudin F, Durand P, Emeriaud G, Essouri S, Pouyau R, Baleine J, Beldjilali S, Bordessoule A, Breinig S, Demaret P, Desprez P, Gaillard-Leroux B, Guichoux J, Guilbert AS, Guillot C, Jean S, Levy M, Noizet-Yverneau O, Rambaud J, Recher M, Reynaud S, Valla F, Radoui K, Faure MA, Ferraro G, Mortamet G. Clinical practice guidelines: management of severe bronchiolitis in infants under 12 months old admitted to a pediatric critical care unit. Intensive Care Med 2023; 49:5-25. [PMID: 36592200 DOI: 10.1007/s00134-022-06918-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/13/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE We present guidelines for the management of infants under 12 months of age with severe bronchiolitis with the aim of creating a series of pragmatic recommendations for a patient subgroup that is poorly individualized in national and international guidelines. METHODS Twenty-five French-speaking experts, all members of the Groupe Francophone de Réanimation et Urgence Pédiatriques (French-speaking group of paediatric intensive and emergency care; GFRUP) (Algeria, Belgium, Canada, France, Switzerland), collaborated from 2021 to 2022 through teleconferences and face-to-face meetings. The guidelines cover five areas: (1) criteria for admission to a pediatric critical care unit, (2) environment and monitoring, (3) feeding and hydration, (4) ventilatory support and (5) adjuvant therapies. The questions were written in the Patient-Intervention-Comparison-Outcome (PICO) format. An extensive Anglophone and Francophone literature search indexed in the MEDLINE database via PubMed, Web of Science, Cochrane and Embase was performed using pre-established keywords. The texts were analyzed and classified according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. When this method did not apply, an expert opinion was given. Each of these recommendations was voted on by all the experts according to the Delphi methodology. RESULTS This group proposes 40 recommendations. The GRADE methodology could be applied for 17 of them (3 strong, 14 conditional) and an expert opinion was given for the remaining 23. All received strong approval during the first round of voting. CONCLUSION These guidelines cover the different aspects in the management of severe bronchiolitis in infants admitted to pediatric critical care units. Compared to the different ways to manage patients with severe bronchiolitis described in the literature, our original work proposes an overall less invasive approach in terms of monitoring and treatment.
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Affiliation(s)
- Christophe Milési
- Pediatric Intensive Care Unit, Montpellier University Hospital, Montpellier, France.
| | - Florent Baudin
- Pediatric Intensive Care Unit, Lyon Hospital Femme-Mère-Enfants, Bron, France
| | - Philippe Durand
- Pediatric Intensive Care Unit, Bicêtre Hospital, Assistance Publique des Hôpitaux de Paris, Kremlin-Bicêtre, France
| | - Guillaume Emeriaud
- Pediatric Intensive Care Unit, Sainte-Justine University Hospital, Montreal, Canada
| | - Sandrine Essouri
- Pediatric Department, Sainte-Justine University Hospital, Montreal, Canada
| | - Robin Pouyau
- Pediatric Intensive Care Unit, Lyon Hospital Femme-Mère-Enfants, Bron, France
| | - Julien Baleine
- Pediatric Intensive Care Unit, Montpellier University Hospital, Montpellier, France
| | - Sophie Beldjilali
- Pediatric Intensive Care Unit, La Timone University Hospital, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Alice Bordessoule
- Pediatric Intensive Care Unit, Geneva University Hospital, Geneva, Switzerland
| | - Sophie Breinig
- Pediatric Intensive Care Unit, Toulouse University Hospital, Toulouse, France
| | - Pierre Demaret
- Intensive Care Unit, Liège University Hospital, Liège, Belgium
| | - Philippe Desprez
- Pediatric Intensive Care Unit, Point-à-Pitre University Hospital, Point-à-Pitre, France
| | | | - Julie Guichoux
- Pediatric Intensive Care Unit, Bordeaux University Hospital, Bordeaux, France
| | - Anne-Sophie Guilbert
- Pediatric Intensive Care Unit, Strasbourg University Hospital, Strasbourg, France
| | - Camille Guillot
- Pediatric Intensive Care Unit, Lille University Hospital, Lille, France
| | - Sandrine Jean
- Pediatric Intensive Care Unit, Trousseau Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Michael Levy
- Pediatric Intensive Care Unit, Robert Debré Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | | | - Jérôme Rambaud
- Pediatric Intensive Care Unit, Trousseau Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Morgan Recher
- Pediatric Intensive Care Unit, Lille University Hospital, Lille, France
| | - Stéphanie Reynaud
- Pediatric Intensive Care Unit, Lyon Hospital Femme-Mère-Enfants, Bron, France
| | - Fréderic Valla
- Pediatric Intensive Care Unit, Lyon Hospital Femme-Mère-Enfants, Bron, France
| | - Karim Radoui
- Pneumology EHS Pediatric Department, Faculté de Médecine d'Oran, Canastel, Oran, Algeria
| | | | - Guillaume Ferraro
- Pediatric Emergency Department, Nice University Hospital, Nice, France
| | - Guillaume Mortamet
- Pediatric Intensive Care Unit, Grenoble-Alpes University Hospital, Grenoble, France
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7
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Jat KR, Dsouza JM, Mathew JL. Continuous positive airway pressure (CPAP) for acute bronchiolitis in children. Cochrane Database Syst Rev 2022; 4:CD010473. [PMID: 35377462 PMCID: PMC8978604 DOI: 10.1002/14651858.cd010473.pub4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Acute bronchiolitis is one of the most frequent causes of emergency department visits and hospitalisation in children up to three years of age. There is no specific treatment for bronchiolitis except for supportive treatment, which includes ensuring adequate hydration and oxygen supplementation. Continuous positive airway pressure (CPAP) aims to widen the lungs' peripheral airways, enabling deflation of overdistended lungs in bronchiolitis. Increased airway pressure also prevents the collapse of poorly supported peripheral small airways during expiration. Observational studies report that CPAP is beneficial for children with acute bronchiolitis. This is an update of a review first published in 2015 and updated in 2019. OBJECTIVES To assess the efficacy and safety of CPAP compared to no CPAP or sham CPAP in infants and children up to three years of age with acute bronchiolitis. SEARCH METHODS We conducted searches of CENTRAL (2021, Issue 7), which includes the Cochrane Acute Respiratory Infections Group Specialised Register, MEDLINE (1946 to August 2021), Embase (1974 to August 2021), CINAHL (1981 to August 2021), and LILACS (1982 to August 2021) in August 2021. We also searched the US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) for completed and ongoing trials on 26 October 2021. SELECTION CRITERIA We considered randomised controlled trials (RCTs), quasi-RCTs, cross-over RCTs, and cluster-RCTs evaluating the effect of CPAP in children with acute bronchiolitis. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility, extracted data using a structured pro forma, analysed data, and performed meta-analyses. We used the Cochrane risk of bias tool to assess risk of bias in the included studies. We created a summary of the findings table employing GRADEpro GDT software. MAIN RESULTS: We included three studies with a total of 122 children (62/60 in intervention/control arms) aged up to 12 months investigating nasal CPAP compared with supportive (or 'standard') therapy. We included one new trial (72 children) in the 2019 update that contributed data to the assessment of respiratory rate and the need for mechanical ventilation for this update. We did not identify any new trials for inclusion in the current update. The included studies were single-centre trials conducted in France, the UK, and India. Two studies were parallel-group RCTs, and one study was a cross-over RCT. The evidence provided by the included studies was of low certainty; we made an assessment of high risk of bias for blinding, incomplete outcome data, and selective reporting, and confidence intervals were wide. The effect of CPAP on the need for mechanical ventilation in children with acute bronchiolitis was uncertain due to risk of bias and imprecision around the effect estimate (risk difference -0.01, 95% confidence interval (CI) -0.09 to 0.08; 3 RCTs, 122 children; low certainty evidence). None of the trials measured time to recovery. Limited, low certainty evidence indicated that CPAP decreased respiratory rate (decreased respiratory rate is better) (mean difference (MD) -3.81, 95% CI -5.78 to -1.84; 2 RCTs, 91 children; low certainty evidence). Only one trial measured change in arterial oxygen saturation (increased oxygen saturation is better), and the results were imprecise (MD -1.70%, 95% CI -3.76 to 0.36; 1 RCT, 19 children; low certainty evidence). The effect of CPAP on change in arterial partial carbon dioxide pressure (pCO₂) (decrease in pCO₂ is better) was imprecise (MD -2.62 mmHg, 95% CI -5.29 to 0.05; 2 RCTs, 50 children; low certainty evidence). Duration of hospital stay was similar in both the CPAP and supportive care groups (MD 0.07 days, 95% CI -0.36 to 0.50; 2 RCTs, 50 children; low certainty evidence). Two studies did not report pneumothorax, but pneumothorax did not occur in one study. No studies reported occurrences of deaths. Several outcomes (change in partial oxygen pressure, hospital admission rate (from the emergency department to hospital), duration of emergency department stay, and need for intensive care unit admission) were not reported in the included studies. AUTHORS' CONCLUSIONS The use of CPAP did not reduce the need for mechanical ventilation in children with bronchiolitis, although the evidence was of low certainty. Limited, low certainty evidence suggests that breathing improved (a decreased respiratory rate) in children with bronchiolitis who received CPAP; this finding is unchanged from the 2015 review and 2019 update. Due to the limited available evidence, the effect of CPAP in children with acute bronchiolitis is uncertain for our other outcomes. Larger, adequately powered trials are needed to evaluate the effect of CPAP for children with acute bronchiolitis.
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Affiliation(s)
- Kana R Jat
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - Joseph L Mathew
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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8
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Mu SC, Chien YH, Lai PZ, Chao KY. Helmet Ventilation for Pediatric Patients During the COVID-19 Pandemic: A Narrative Review. Front Pediatr 2022; 10:839476. [PMID: 35186812 PMCID: PMC8847782 DOI: 10.3389/fped.2022.839476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/11/2022] [Indexed: 12/15/2022] Open
Abstract
The air dispersion of exhaled droplets from patients is currently considered a major route of coronavirus disease 2019 (COVID-19) transmission, the use of non-invasive ventilation (NIV) should be more cautiously employed during the COVID-19 pandemic. Recently, helmet ventilation has been identified as the optimal treatment for acute hypoxia respiratory failure caused by COVID-19 due to its ability to deliver NIV respiratory support with high tolerability, low air leakage, and improved seal integrity. In the present review, we provide an evidence-based overview of the use of helmet ventilation in children with respiratory failure.
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Affiliation(s)
- Shu-Chi Mu
- Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Yu-Hsuan Chien
- Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,Department of Pediatrics, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Pin-Zhen Lai
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Ke-Yun Chao
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan.,School of Physical Therapy, Graduate Institute of Rehabilitation Sciences, Chang Gung University, Taoyuan, Taiwan
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9
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Coppadoro A, Zago E, Pavan F, Foti G, Bellani G. The use of head helmets to deliver noninvasive ventilatory support: a comprehensive review of technical aspects and clinical findings. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:327. [PMID: 34496927 PMCID: PMC8424168 DOI: 10.1186/s13054-021-03746-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/20/2021] [Indexed: 11/14/2022]
Abstract
A helmet, comprising a transparent hood and a soft collar, surrounding the patient’s head can be used to deliver noninvasive ventilatory support, both as continuous positive airway pressure and noninvasive positive pressure ventilation (NPPV), the latter providing active support for inspiration. In this review, we summarize the technical aspects relevant to this device, particularly how to prevent CO2 rebreathing and improve patient–ventilator synchrony during NPPV. Clinical studies describe the application of helmets in cardiogenic pulmonary oedema, pneumonia, COVID-19, postextubation and immune suppression. A section is dedicated to paediatric use. In summary, helmet therapy can be used safely and effectively to provide NIV during hypoxemic respiratory failure, improving oxygenation and possibly leading to better patient-centred outcomes than other interfaces.
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Affiliation(s)
| | - Elisabetta Zago
- ASST Monza, San Gerardo Hospital, Monza, Italy.,Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB, Italy
| | - Fabio Pavan
- ASST Monza, San Gerardo Hospital, Monza, Italy.,Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB, Italy
| | - Giuseppe Foti
- ASST Monza, San Gerardo Hospital, Monza, Italy.,Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB, Italy
| | - Giacomo Bellani
- ASST Monza, San Gerardo Hospital, Monza, Italy. .,Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB, Italy.
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10
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Tang G, Lin J, Zhang Y, Shi Q. The Effects and Safety of Continuous Positive Airway Pressure in Children with Bronchiolitis: A Systematic Review and Meta-Analysis. J Trop Pediatr 2021; 67:6284363. [PMID: 34037790 DOI: 10.1093/tropej/fmaa128] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To evaluate the effects and safety of continuous positive airway pressure (CPAP) for initial respiratory management of bronchiolitis. METHODS PubMed, EMBASE, Cochrane Library, CNKI, Wanfang data and CQ VIP were searched until 17 June 2020. Randomized controlled trials (RCTs) which investigated the effect of CPAP for bronchiolitis were included. RESULTS Twenty-seven RCTs met the eligibility criteria. In the comparison of CPAP versus standard oxygen therapy, CPAP can reduce the length of stay (LOS) in hospital, respiratory rate (RR), PaCO2, heart rate, mechanical ventilation and increase PaO2, but the SpO2 and PH were not improved. In the comparison of CPAP versus high-flow nasal cannula, CPAP can reduce treatment failure, but the PICU LOS, Incidence of intubation, RR, Modified Woods Clinical Asthma Score were not decreased. Treatment failure may be less in helmet comparing with the mask though there was no quantitative analysis. CONCLUSION CPAP for the initial respiratory management significantly benefit children with bronchiolitis, the delivery of CPAP by helmet may be a better choice. More high-quality research is needed to confirm the conclusion.
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Affiliation(s)
- Guojing Tang
- Department of Critical Care Medicine Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Ministry of Education, Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Jilei Lin
- Department of Respiration Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Ministry of Education, Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Yin Zhang
- Department of Respiration Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Ministry of Education, Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Qingxia Shi
- Department of Respiration Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Ministry of Education, Key Laboratory of Child Development and Disorders, Chongqing, China
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11
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Wang T, Yin H, Xu Q, Jiang X, Yu T. Use of a helmet for oxygen therapy in critically ill patients: a systematic review and meta-analysis. J Int Med Res 2021; 48:300060520903209. [PMID: 32212877 PMCID: PMC7254593 DOI: 10.1177/0300060520903209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Tao Wang
- Department of Critical Care Medicine, Research Center for Functional Maintenance and Reconstruction of Viscera, Wannan Medical College First Affiliated Hospital, Yijishan Hospital, Wuhu, China
| | - Hongzhen Yin
- Department of Critical Care Medicine, Research Center for Functional Maintenance and Reconstruction of Viscera, Wannan Medical College First Affiliated Hospital, Yijishan Hospital, Wuhu, China
| | - Qiancheng Xu
- Department of Critical Care Medicine, Research Center for Functional Maintenance and Reconstruction of Viscera, Wannan Medical College First Affiliated Hospital, Yijishan Hospital, Wuhu, China
| | - Xiaogan Jiang
- Department of Critical Care Medicine, Research Center for Functional Maintenance and Reconstruction of Viscera, Wannan Medical College First Affiliated Hospital, Yijishan Hospital, Wuhu, China
| | - Tao Yu
- Department of Neurosurgical Intensive Care Unit, Research Center for Functional Maintenance and Reconstruction of Viscera, Wannan Medical College First Affiliated Hospital, Yijishan Hospital, Wuhu, China
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12
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Hong S, Wang H, Tian Y, Qiao L. The roles of noninvasive mechanical ventilation with helmet in patients with acute respiratory failure: A systematic review and meta-analysis. PLoS One 2021; 16:e0250063. [PMID: 33857228 PMCID: PMC8049716 DOI: 10.1371/journal.pone.0250063] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/30/2021] [Indexed: 11/19/2022] Open
Abstract
Objective To compare the safety and effectiveness between helmet and face mask noninvasive mechanical ventilation (NIMV) in patients with acute respiratory failure (ARF). Methods English databases included PubMed, EMBASE, Cochrane Central Register of Controlled Trials and Web of Science. Chinese databases involved Wanfang Data, China Knowledge Resource Integrated Database and Chinese Biological Medicine Database. Randomized controlled trials (RCTs) comparing helmet and face mask NIMV for patients with ARF were searched. Meta-analysis was performed using Review manager 5.1.0. Results Twelve trials with a total of 569 patients were eligible. Our meta-analysis showed that, comparing with face mask, helmet could significantly decrease the incidences of intolerance [risk ratio (RR) 0.19; 95% confidence interval (CI) 0.09−0.39], facial skin ulcer (RR 0.19; 95% CI 0.08−0.43) and aerophagia (RR 0.15; 95% CI 0.06−0.37), reduce respiratory rate [mean difference (MD) -3.10; 95% CI -4.85 to -1.34], intubation rate (RR 0.39; 95% CI 0.26−0.59) and hospital mortality (RR 0.62; 95% CI 0.39−0.99) in patients with ARF, and improve oxygenation index in patients with hypoxemic ARF (MD 55.23; 95% CI 31.37−79.09). However, subgroupanalysis for hypercapnic ARF revealed that PaCO2 was significantly reduced in face mask group compared with helmet group (MD 5.34; 95% CI 3.41−7.27). Conclusion NIMV with helmet can improve the patient’s tolerance, reduce adverse events, increase oxygenation effect, and decrease intubation rate and hospital mortality comparing to face mask. However, the low number of patients from included studies may preclude strong conclusions. Large RCTs are still needed to provide more robust evidence.
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Affiliation(s)
- Shukun Hong
- Department of Intensive Care Unit, Shengli Oilfield Central Hospital, Dongying, China
- * E-mail:
| | - Hongye Wang
- Department of Obstetrics and Gynecology, Shengli Oilfield Central Hospital, Dongying, China
| | - Yonggang Tian
- Department of Intensive Care Unit, Shengli Oilfield Central Hospital, Dongying, China
| | - Lujun Qiao
- Department of Intensive Care Unit, Shengli Oilfield Central Hospital, Dongying, China
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13
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Di Bella C, Araos J, Lacitignola L, Grasso S, De Marzo L, Crovace AM, Staffieri F. Effects of continuous positive airway pressure administered by a helmet in cats under general anaesthesia. J Feline Med Surg 2021; 23:337-343. [PMID: 32840420 PMCID: PMC10812219 DOI: 10.1177/1098612x20951279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the respiratory effects of non-invasive continuous positive airway pressure (CPAP) administered by a helmet in healthy cats under anaesthesia. METHODS Fifteen healthy male cats scheduled for castration were anaesthetised with medetomidine (20 µg/kg), ketamine (10 mg/kg) and buprenorphine (20 µg/kg) intramuscularly. When an adequate level of anaesthesia was achieved, a paediatric helmet was placed on all subjects. The helmet was connected to a Venturi valve supplied with medical air and cats received the following phases of treatments: 0 cmH2O (pre-CPAP), 5 cmH2O (CPAP) and 0 cmH2O (post-CPAP). Each treatment lasted 10 mins. At the end of each phase an arterial blood sample was drawn. The following data were also collected: mean arterial pressure, respiratory rate, heart rate and the anaesthesia level score (0 = awake, 10 = deep anaesthesia). The alveolar to arterial oxygen gradient (P[A-a]O2) and the venous admixture (Fshunt) were also estimated. Data were analysed with two-way ANOVA (P <0.05). RESULTS The arterial partial pressure of oxygen was higher (P <0.001) at CPAP (103.2 ± 5.1 mmHg) vs pre-CPAP (77.5 ± 7.4 mmHg) and post-CPAP (84.6 ± 8.1 mmHg). The P(A-a)O2 and the Fshunt were lower (P <0.001) at CPAP (4.4 ± 2.3 mmHg; 7.4 ± 3.1%) vs pre-CPAP (18.9 ± 6.4 mmHg; 22.8 ± 4.6%) and post-CPAP (15.6 ± 7.3 mmHg; 20.9 ± 4.6 %). No other parameters differed between groups. CONCLUSIONS AND RELEVANCE Non-invasive CPAP applied by a helmet improves oxygenation in cats under injectable general anaesthesia.
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Affiliation(s)
- Caterina Di Bella
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organs Transplantation, University of Bari ‘Aldo Moro’, Valenzano, Bari, Italy
| | - Joaquin Araos
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY, USA
| | - Luca Lacitignola
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organs Transplantation, University of Bari ‘Aldo Moro’, Valenzano, Bari, Italy
| | - Salvatore Grasso
- Section of Anaesthesia and Intensive Care, Department of Emergency and Organs Transplantation, University of Bari ‘Aldo Moro’, Bari, Italy
| | - Linda De Marzo
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organs Transplantation, University of Bari ‘Aldo Moro’, Valenzano, Bari, Italy
| | - Alberto Maria Crovace
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organs Transplantation, University of Bari ‘Aldo Moro’, Valenzano, Bari, Italy
| | - Francesco Staffieri
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organs Transplantation, University of Bari ‘Aldo Moro’, Valenzano, Bari, Italy
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14
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Angurana SK, Williams V, Takia L. Acute Viral Bronchiolitis: A Narrative Review. J Pediatr Intensive Care 2020; 12:79-86. [PMID: 37082471 PMCID: PMC10113010 DOI: 10.1055/s-0040-1715852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 07/09/2020] [Indexed: 10/23/2022] Open
Abstract
AbstractAcute viral bronchiolitis (AVB) is the leading cause of hospital admissions among infants in developed and developing countries and associated with increased morbidity and cost of treatment. This review was performed to guide the clinicians managing AVB in light of evidence accumulated in the last decade. We searched published English literature in last decade regarding etiology, diagnosis, treatment, and prevention of AVB using PubMed and Cochrane Database of Systematic Reviews. Respiratory syncytial virus is the most common causative agent. The diagnosis is mainly clinical with limited role of diagnostic investigations and chest radiographs are not routinely indicated. The management of AVB remains a challenge, as the role of various interventions is not clear. Supportive care in from of provision of heated and humidified oxygen and maintaining hydration are main interventions. The use of pulse oximetry helps to guide the administration of oxygen. Trials and systematic reviews evaluated various interventions like nebulized adrenaline, bronchodilators and hypertonic saline, corticosteroids, different modes of noninvasive ventilation (high-flow nasal cannula [HFNC], continuous positive airway pressure [CPAP], and noninvasive positive pressure ventilation [NPPV]), surfactant, heliox, chest physiotherapy, and antiviral drugs. The interventions which showed some benefits in infants and children with AVB are adrenaline and hypertonic saline nebulization, HFNC, CPAP, NIV, and surfactant. The routine administration of antibiotics, bronchodilators, corticosteroids, steam inhalation, chest physiotherapy, heliox, and antiviral drugs are not recommended.
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Affiliation(s)
- Suresh K. Angurana
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vijai Williams
- Pediatric Intensive Care Unit, Gleneagles Global Hospitals, Perumbakkam, Chennai, India
| | - Lalit Takia
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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15
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Manso Ruiz de la Cuesta R, del Villar Guerra P, Medina Villanueva A, Modesto Alapont V, Molinos Norniella C, Bartolomé Albistegui MJ, García González V. CPAP vs therapy in infants being transported due to acute respiratory failure. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.anpede.2019.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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16
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Schünemann HJ, Khabsa J, Solo K, Khamis AM, Brignardello-Petersen R, El-Harakeh A, Darzi A, Hajizadeh A, Bognanni A, Bak A, Izcovich A, Cuello-Garcia CA, Chen C, Borowiack E, Chamseddine F, Schünemann F, Morgano GP, Muti-Schünemann GEU, Chen G, Zhao H, Neumann I, Brozek J, Schmidt J, Hneiny L, Harrison L, Reinap M, Junek M, Santesso N, El-Khoury R, Thomas R, Nieuwlaat R, Stalteri R, Yaacoub S, Lotfi T, Baldeh T, Piggott T, Zhang Y, Saad Z, Rochwerg B, Perri D, Fan E, Stehling F, Akl IB, Loeb M, Garner P, Aston S, Alhazzani W, Szczeklik W, Chu DK, Akl EA. Ventilation Techniques and Risk for Transmission of Coronavirus Disease, Including COVID-19: A Living Systematic Review of Multiple Streams of Evidence. Ann Intern Med 2020; 173:204-216. [PMID: 32442035 PMCID: PMC7281716 DOI: 10.7326/m20-2306] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Mechanical ventilation is used to treat respiratory failure in coronavirus disease 2019 (COVID-19). PURPOSE To review multiple streams of evidence regarding the benefits and harms of ventilation techniques for coronavirus infections, including that causing COVID-19. DATA SOURCES 21 standard, World Health Organization-specific and COVID-19-specific databases, without language restrictions, until 1 May 2020. STUDY SELECTION Studies of any design and language comparing different oxygenation approaches in patients with coronavirus infections, including severe acute respiratory syndrome (SARS) or Middle East respiratory syndrome (MERS), or with hypoxemic respiratory failure. Animal, mechanistic, laboratory, and preclinical evidence was gathered regarding aerosol dispersion of coronavirus. Studies evaluating risk for virus transmission to health care workers from aerosol-generating procedures (AGPs) were included. DATA EXTRACTION Independent and duplicate screening, data abstraction, and risk-of-bias assessment (GRADE for certainty of evidence and AMSTAR 2 for included systematic reviews). DATA SYNTHESIS 123 studies were eligible (45 on COVID-19, 70 on SARS, 8 on MERS), but only 5 studies (1 on COVID-19, 3 on SARS, 1 on MERS) adjusted for important confounders. A study in hospitalized patients with COVID-19 reported slightly higher mortality with noninvasive ventilation (NIV) than with invasive mechanical ventilation (IMV), but 2 opposing studies, 1 in patients with MERS and 1 in patients with SARS, suggest a reduction in mortality with NIV (very-low-certainty evidence). Two studies in patients with SARS report a reduction in mortality with NIV compared with no mechanical ventilation (low-certainty evidence). Two systematic reviews suggest a large reduction in mortality with NIV compared with conventional oxygen therapy. Other included studies suggest increased odds of transmission from AGPs. LIMITATION Direct studies in COVID-19 are limited and poorly reported. CONCLUSION Indirect and low-certainty evidence suggests that use of NIV, similar to IMV, probably reduces mortality but may increase the risk for transmission of COVID-19 to health care workers. PRIMARY FUNDING SOURCE World Health Organization. (PROSPERO: CRD42020178187).
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Affiliation(s)
- Holger J Schünemann
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Joanne Khabsa
- American University of Beirut Medical Center, Beirut, Lebanon (J.K., A.E., F.C., L.H., R.E., S.Y., Z.S., I.B.A., E.A.A.)
| | - Karla Solo
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | | | - Romina Brignardello-Petersen
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Amena El-Harakeh
- American University of Beirut Medical Center, Beirut, Lebanon (J.K., A.E., F.C., L.H., R.E., S.Y., Z.S., I.B.A., E.A.A.)
| | - Andrea Darzi
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Anisa Hajizadeh
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Antonio Bognanni
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Anna Bak
- Evidence Prime, Krakow, Poland (A.B., E.B.)
| | - Ariel Izcovich
- German Hospital of Buenos Aires, Buenos Aires, Argentina (A.I.)
| | - Carlos A Cuello-Garcia
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Chen Chen
- Guangzhou University of Chinese Medicine, Guangzhou, China (C.C.)
| | | | - Fatimah Chamseddine
- American University of Beirut Medical Center, Beirut, Lebanon (J.K., A.E., F.C., L.H., R.E., S.Y., Z.S., I.B.A., E.A.A.)
| | - Finn Schünemann
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Gian Paolo Morgano
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | | | - Guang Chen
- Beijing University of Chinese Medicine, Beijing, China (G.C.)
| | - Hong Zhao
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China (H.Z.)
| | - Ignacio Neumann
- McMaster University, Hamilton, Ontario, Canada, and Pontificia Universidad Católica de Chile, Santiago, Chile (I.N.)
| | - Jan Brozek
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Joel Schmidt
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Layal Hneiny
- American University of Beirut Medical Center, Beirut, Lebanon (J.K., A.E., F.C., L.H., R.E., S.Y., Z.S., I.B.A., E.A.A.)
| | - Leila Harrison
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Marge Reinap
- London School of Hygiene and Tropical Medicine, London United Kingdom (M.R.)
| | - Mats Junek
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Nancy Santesso
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Rayane El-Khoury
- American University of Beirut Medical Center, Beirut, Lebanon (J.K., A.E., F.C., L.H., R.E., S.Y., Z.S., I.B.A., E.A.A.)
| | - Rebecca Thomas
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom (R.T., P.G.)
| | - Robby Nieuwlaat
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Rosa Stalteri
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Sally Yaacoub
- American University of Beirut Medical Center, Beirut, Lebanon (J.K., A.E., F.C., L.H., R.E., S.Y., Z.S., I.B.A., E.A.A.)
| | - Tamara Lotfi
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Tejan Baldeh
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Thomas Piggott
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Yuan Zhang
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Zahra Saad
- American University of Beirut Medical Center, Beirut, Lebanon (J.K., A.E., F.C., L.H., R.E., S.Y., Z.S., I.B.A., E.A.A.)
| | - Bram Rochwerg
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Dan Perri
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Eddy Fan
- Toronto General Hospital, Toronto, Ontario, Canada (E.F.)
| | | | - Imad Bou Akl
- American University of Beirut Medical Center, Beirut, Lebanon (J.K., A.E., F.C., L.H., R.E., S.Y., Z.S., I.B.A., E.A.A.)
| | - Mark Loeb
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Paul Garner
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom (R.T., P.G.)
| | - Stephen Aston
- Liverpool University Hospitals NHS Trust, Liverpool, United Kingdom (S.A.)
| | - Waleed Alhazzani
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | | | - Derek K Chu
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Elie A Akl
- American University of Beirut Medical Center, Beirut, Lebanon (J.K., A.E., F.C., L.H., R.E., S.Y., Z.S., I.B.A., E.A.A.)
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Rondelli V, Guarracino A, Iacobellis P, Grasso S, Stripoli T, Lacitignola L, Auriemma E, Romano F, Araos JD, Staffieri F. Evaluation of the effects of helmet continuous positive airway pressure on laryngeal size in dogs anesthetized with propofol and fentanyl using computed tomography. J Vet Emerg Crit Care (San Antonio) 2020; 30:543-549. [PMID: 32649044 DOI: 10.1111/vec.12977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 03/31/2019] [Accepted: 04/29/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate the effect of 5 cm H2 O of continuous positive airway pressure (CPAP) on laryngeal size in spontaneously breathing anesthetized dogs via computed tomography (CT). DESIGN Prospective, randomized, cross-over clinical study. SETTING University teaching hospital and referral private practice. ANIMALS Eight healthy client-owned dogs undergoing CT. INTERVENTIONS Dogs were sedated with acepromazine 20 μg/kg IM and induced with fentanyl 2 μg/kg and propofol 3-5 mg/kg IV before being maintained on fentanyl (5 μg/kg/h) and propofol (0.3 mg/kg/min) constant rate infusion. Dogs received an air/oxygen mixture with (CPAP) and without (NO-CPAP) 5 cm H2 O of CPAP in a random order. Each study step lasted 15 minutes. MEASUREMENTS AND MAIN RESULTS Ten minutes after the beginning of each study period, a CT scan of the laryngeal region was obtained at end-expiration. CT images were analyzed to determine the laryngeal cross-sectional area (CSA; cm2 ), total volume (VTOT ; cm3 ), and laterolateral and dorsoventral diameters (DLL and DDV , respectively; cm). Differences between the 2 treatments were analyzed with t-test for paired data (P < 0.05). Compared to the NO-CPAP, during CPAP the CSA increased by 53.3 ± 23.1% (ie, from 3.3 ± 0.8 to 5.1 ± 1.3 cm2 , P = 0.0004), VTOT increased by 52.4 ± 13.6% (from 6.2 ± 1.7 to 9.4 ± 2.4 cm3 , P < 0.0001), and DLL and DDV were 55.5 ± 13.3% (3.6 ± 0.8 vs 2.4 ± 0.5 cm, P = 0.006) and 20.3 ± 8.8% larger (3.2 ± 0.7 vs 2.7 ± 0.6 cm, P = 0.0002), respectively. CONCLUSIONS Laryngeal volume and cross sectional area increased during the application of 5 cm H2 O of helmet CPAP in spontaneously breathing anesthetized dogs.
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Affiliation(s)
| | - Alessandro Guarracino
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplants, University of Bari Aldo Moro, Bari, Italy
| | - Pierpaolo Iacobellis
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplants, University of Bari Aldo Moro, Bari, Italy
| | - Salvatore Grasso
- Section of Anesthesia and Intensive Care, Department of Emergency and Organ Transplants, University of Bari Aldo Moro, Bari, Italy
| | - Tania Stripoli
- Section of Anesthesia and Intensive Care, Department of Emergency and Organ Transplants, University of Bari Aldo Moro, Bari, Italy
| | - Luca Lacitignola
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplants, University of Bari Aldo Moro, Bari, Italy
| | | | | | - Joaquin D Araos
- Centre Hospitalier Universitaire Veterinaire, Faculte de Medecine Veterinaire, Universite de Montreal, Montreal, Québec, Canada
| | - Francesco Staffieri
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplants, University of Bari Aldo Moro, Bari, Italy
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Manso Ruiz de la Cuesta R, Del Villar Guerra P, Medina Villanueva A, Modesto Alaport V, Molinos Norniella C, Bartolomé Albistegui MJ, García González V. [CPAP vs oxygen therapy in infants being transported due to acute respiratory failure]. An Pediatr (Barc) 2020; 93:152-160. [PMID: 32044198 DOI: 10.1016/j.anpedi.2019.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/18/2019] [Accepted: 07/25/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE The aims of our study are to evaluate the effectiveness and security of CPAP (continuous positive airway pressure) in infants transferred with acute respiratory failure (ARF) and to compare their evolution in PICU between CPAP vs oxygen therapy. MATERIALS AND METHODS We conducted a retrospective observational and analytical study by reviewing the health records of infants with ARF aged 0 to 12months that required interhospital transfer to the PICU. RESULTS We included 110 patients: 71 transported with CPAP and 39 with oxygen therapy. The main cause of ARF was acute bronchiolitis (81.8%). The median level of CPAP was 7cmH2O (interquartile range, 6-7). Controlling by the previous values in specific multivariable models, CPAP produced a significant decrease in the Wood-Downes score (beta = -1.08; 95% CI = -1.76 to -0.40; P = .002) and the heart rate (beta = -19.64, 95% CI = -28.46 to -10.81; P < .001). No patients required endotracheal intubation during transport. During the PICU stay, the intubation rate was similar in the CPAP group (7%) and the oxygen therapy group (5.1%) (P=.689). The proportion of patients that required bilevel positive airway pressure within 6hours of admission to the PICU was higher in the oxygen therapy group: 100% (11/11) vs 69.2% (18/26), P=.04. CONCLUSIONS Early administration of CPAP to infants with ARF was a safe respiratory support intervention during interhospital transport. During patient transport, the use of CPAP achieved greater decreases in the Wood-Downes score and heart rate compared to oxygen therapy.
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Affiliation(s)
| | | | | | - Vicent Modesto Alaport
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitari i Politècnic La Fe de València, Valencia, España
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Franklin D, Fraser JF, Schibler A. Respiratory support for infants with bronchiolitis, a narrative review of the literature. Paediatr Respir Rev 2019; 30:16-24. [PMID: 31076380 DOI: 10.1016/j.prrv.2018.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/04/2018] [Indexed: 11/19/2022]
Abstract
Bronchiolitis is a common viral disease that significantly affects infants less than 12 months of age. The purpose of this review is to present a review of the current knowledge of the uses of respiratory support in the management of infants with bronchiolitis presenting to hospital. We electronically searched MEDLINE, Cochrane, CINAHL and EMBASE (inception to 25th March 2018), to manually search for clinical trials that address the management strategies for respiratory support of infants with bronchiolitis. We identified 120 papers who met the inclusion criteria, of which 33 papers were relevant for this review with only nine randomized controlled trials. This review demonstrated that non-invasive respiratory support reduced the need for escalation of therapy, particularly the proportion of intubations required for infants with bronchiolitis. Additionally, clear economic benefits have been demonstrated when non-invasive ventilation has been used. The potential early use of non-invasive respiratory supports such as nasal high flow therapy and non-invasive ventilation may have an impact on health care costs and reduction in ICU admissions and intubation rates. High-grade evidence demonstrates safety and quality of high flow therapy in general ward settings.
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Affiliation(s)
- Donna Franklin
- Paediatric Critical Care Research Group, Lady Cilento Children's Hospital, Australia; Mater Research Institute, The University of Queensland, Brisbane, Australia; The University of Queensland, School of Medicine, Brisbane, Australia; Critical Care Research Group, Adult Intensive Care Service, The Prince Charles Hospital, Brisbane, Australia.
| | - John F Fraser
- The University of Queensland, School of Medicine, Brisbane, Australia; Critical Care Research Group, Adult Intensive Care Service, The Prince Charles Hospital, Brisbane, Australia
| | - Andreas Schibler
- Paediatric Critical Care Research Group, Lady Cilento Children's Hospital, Australia; Mater Research Institute, The University of Queensland, Brisbane, Australia; The University of Queensland, School of Medicine, Brisbane, Australia
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Abstract
BACKGROUND Acute bronchiolitis is one of the most frequent causes of emergency department visits and hospitalisation in children. There is no specific treatment for bronchiolitis except for supportive treatment, which includes ensuring adequate hydration and oxygen supplementation. Continuous positive airway pressure (CPAP) aims to widen the lungs' peripheral airways, enabling deflation of overdistended lungs in bronchiolitis. Increased airway pressure also prevents the collapse of poorly supported peripheral small airways during expiration. Observational studies report that CPAP is beneficial for children with acute bronchiolitis. This is an update of a review first published in 2015. OBJECTIVES To assess the efficacy and safety of CPAP compared to no CPAP or sham CPAP in infants and children up to three years of age with acute bronchiolitis. SEARCH METHODS We conducted searches of CENTRAL (2017, Issue 12), which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (1946 to December, 2017), Embase (1974 to December 2017), CINAHL (1981 to December 2017), and LILACS (1982 to December 2017) in January 2018. SELECTION CRITERIA We considered randomised controlled trials (RCTs), quasi-RCTs, cross-over RCTs, and cluster-RCTs evaluating the effect of CPAP in children with acute bronchiolitis. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility, extracted data using a structured pro forma, analysed data, and performed meta-analyses. MAIN RESULTS We included three studies with a total of 122 children (62/60 in intervention/control arms) aged up to 12 months that investigated nasal CPAP compared with supportive (or "standard") therapy. We included one new trial (72 children) that contributed data to the assessment of respiratory rate and need for mechanical ventilation for this update. The included studies were single-centre trials conducted in France, the UK, and India. Two studies were parallel-group RCTs and one was a cross-over RCT. The evidence provided by the included studies was low quality; we assessed high risk of bias for blinding, incomplete outcome data, and selective reporting, and confidence intervals were wide.The effect of CPAP on the need for mechanical ventilation in children with acute bronchiolitis was uncertain due to imprecision around the effect estimate (3 RCTs, 122 children; risk ratio (RR) 0.69, 95% confidence interval (CI) 0.14 to 3.36; low-quality evidence). None of the trials measured time to recovery. Limited, low-quality evidence indicated that CPAP decreased respiratory rate (2 RCTs, 91 children; mean difference (MD) -3.81, 95% CI -5.78 to -1.84). Only one trial measured change in arterial oxygen saturation, and the results were imprecise (19 children; MD -1.70%, 95% CI -3.76 to 0.36). The effect of CPAP on change in arterial partial carbon dioxide pressure (pCO₂) was imprecise (2 RCTs, 50 children; MD -2.62 mmHg, 95% CI -5.29 to 0.05; low-quality evidence). Duration of hospital stay was similar in both CPAP and supportive care groups (2 RCTs, 50 children; MD 0.07 days, 95% CI -0.36 to 0.50; low-quality evidence). Two studies did not report about pneumothorax, but pneumothorax did not occur in one study. No studies reported occurrences of deaths. Several outcomes (change in partial oxygen pressure, hospital admission rate (from emergency department to hospital), duration of emergency department stay, and need for intensive care unit admission) were not reported in the included studies. AUTHORS' CONCLUSIONS Limited, low-quality evidence suggests that breathing improved (a decreased respiratory rate) in children with bronchiolitis who received CPAP; this finding is unchanged from the 2015 review. Further evidence for this outcome was provided by the inclusion of a low-quality study for the 2018 update. Due to the limited available evidence, the effect of CPAP in children with acute bronchiolitis is uncertain for other outcomes. Larger, adequately powered trials are needed to evaluate the effect of CPAP for children with acute bronchiolitis.
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Affiliation(s)
- Kana R Jat
- All India Institute of Medical Sciences (AIIMS)Department of PediatricsAnsari NagarNew DelhiDelhiIndia110029
| | - Joseph L Mathew
- Post Graduate Institute of Medical Education and ResearchDepartment of PediatricsChandigarhIndia160012
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Wolfler A, Raimondi G, Pagan de Paganis C, Zoia E. The infant with severe bronchiolitis: from high flow nasal cannula to continuous positive airway pressure and mechanical ventilation. Minerva Pediatr 2018; 70:612-622. [DOI: 10.23736/s0026-4946.18.05358-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Temporal Changes in Prescription of Neuropharmacologic Drugs and Utilization of Resources Related to Neurologic Morbidity in Mechanically Ventilated Children With Bronchiolitis. Pediatr Crit Care Med 2017; 18:e606-e614. [PMID: 28930813 DOI: 10.1097/pcc.0000000000001351] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Critically ill children with bronchiolitis may require neuropharmacologic medications and support for neuro-functional sequelae, but current practices are not well described. We aimed to describe recent trends in neuropharmacology and utilization of neuro-rehabilitation resources in mechanically ventilated children with bronchiolitis. DESIGN Analysis of the multicenter Pediatric Health Information System database. SETTING Forty-seven U.S. children's hospitals. PATIENTS PICU patients less than 2 years old with bronchiolitis undergoing mechanical ventilation between 2006 and 2015. INTERVENTIONS None. Annual rates of utilization of neuropharmacologic medications (sedatives, analgesics, etc) and of neuro-rehabilitation services (physical therapy, neurologic consultation, etc) over the 10-year study period were compared. MEASUREMENTS AND MAIN RESULTS Neuropharmacologic medications prescribed on greater than or equal to 2 days were extracted. Utilization of MRI of the brain, neurologic consultation, swallow evaluation, occupational therapy, and physical therapy was also extracted. Among 12,508 subjects, the median age was 2.8 months, ~50% had comorbid conditions, and the median duration of mechanical ventilation was 7 days. The percentage of children prescribed greater than or equal to five drugs/drug classes increased over the study period from 36.5% to 55.8% (p < 0.001). There were significant increases over time in utilization of 10 of the 15 individual drugs/drug classes analyzed. More than half of subjects (6,294 [50.3%]) received at least one service that evaluates/treats neurologic morbidity. There were significant increases in the use of greater than or equal to one service (36.3% in 2006 to 59.6% in 2015; p < 0.001) and in the use of greater than or equal to two services (20.8% to 34.8%; p < 0.001). Utilization of each of the five individual resources increased significantly during the study period, but use of vasoactive medications and mortality did not. CONCLUSIONS Prescription of neuropharmacologic agents increased over time using metrics of both overall drug burden and specific drug usage. Concurrently, the utilization of services that evaluate and/or treat neurologic morbidity was common and also increased over time.
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De Luca D. Noninvasive high-frequency ventilation and the errors from the past: designing simple trials neglecting complex respiratory physiology. J Perinatol 2017; 37:1065-1066. [PMID: 28904405 DOI: 10.1038/jp.2017.84] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, Medical Center 'A.Béclère', South Paris University Hospitals, APHP and South Paris-Saclay University, Paris, France.,Institute of Anesthesiology and Critical Care, Catholic University of the Sacred Heart, Rome, Italy
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Frassoni E, Shankar-Aguilera S, Yousef N, De Luca D. Helmet-Delivered Respiratory Support in Neonate with Severe Facial Malformation. J Paediatr Child Health 2017; 53:825. [PMID: 28770570 DOI: 10.1111/jpc.13635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 04/12/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Elisa Frassoni
- Division of Paediatrics and Neonatal Critical Care, APHP, South Paris University Hospitals, Medical Centre "A.Béclère", Paris, France
| | - Shivani Shankar-Aguilera
- Division of Paediatrics and Neonatal Critical Care, APHP, South Paris University Hospitals, Medical Centre "A.Béclère", Paris, France
| | - Nadya Yousef
- Division of Paediatrics and Neonatal Critical Care, APHP, South Paris University Hospitals, Medical Centre "A.Béclère", Paris, France
| | - Daniele De Luca
- Division of Paediatrics and Neonatal Critical Care, APHP, South Paris University Hospitals, Medical Centre "A.Béclère", Paris, France
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