Abstract
Continuous positive airway pressure (CPAP) has been used in infants with bronchiolitis for decades. Recently, high flow nasal cannula (HFNC) therapy was introduced. We conducted a trial of 50 children with bronchiolitis who were randomized to treatment with CPAP or HFNC. Objectives were to compare the development in respiratory rate, pCO2, and Modified Woods Clinical Asthma Score (M-WCAS) in young children with bronchiolitis, treated with CPAP or HFNC. Secondarily, to compare Neonatal Infant Pain Score (NIPS), treatment duration, treatment failure, and hospitalization length. Median age at inclusion was 2.8 (CPAP group) vs 2.1 months (HFNC group). Mean baseline pCO2 was 6.7 in both groups and mean respiratory rate was 60 vs 56 in the CPAP and HFNC group respectively. No differences were observed in development of respiratory rate, pCO2, or M-WCAS. NIPS was higher in the CPAP group. Treatment failure was scarce in both groups. No significant differences in treatment duration or length of hospitalization were observed.
Conclusion: In infants and young children with bronchiolitis, HFNC may be an effective and pleasant alternative to CPAP. Larger multicenter studies are needed to further explore differences in treatment failure and treatment duration.
Trial registration: www.clinicaltrial.gov. id NCT02618213, registration date December 1, 2015.
What is Known: • CPAP has been used for many years for respiratory support in infant bronchiolitis. The method requires special staff skills and may be stressful to the child. • HFNC has been introduced as a newer tool. | |
What is New: • In infants with bronchiolitis, HFNC and CPAP were comparable in decreasing respiratory rate, pCO2, and need for oxygen supply. • Pain score during therapy was lower in the HFNC group. |
Similar content being viewed by others
Abbreviations
- RSV:
-
Respiratory syncytial virus
- CPAP:
-
Continuous positive airway pressure
- HFNC:
-
High flow oxygenation therapy
- RR:
-
Respiratory rate
- M-WCAS:
-
Modified Woods Clinical Asthma Score
- NIPS:
-
Neonatal Infant Pain Score
- FLACC:
-
Face Leg Activity Cry and Consolability
- PICU:
-
Pediatric intensive care unit
- FIO2:
-
Fraction of inhaled oxygen
References
Bressan S, Balzani M, Krauss B, Pettenazzo A, Zanconato S, Baraldi E (2013) High-flow nasal cannula oxygen for bronchiolitis in a pediatric ward: a pilot study. Eur J Pediatr 172:1649–1656. https://doi.org/10.1007/s00431-013-2094-4
Duarte-Dorado DM, Madero-Orostegui DS, Rodriguez-Martinez CE, Nino G (2013) Validation of a scale to assess the severity of bronchiolitis in a population of hospitalized infants. J Asthma 50:1056–1061. https://doi.org/10.3109/02770903.2013.834504
Ganu SS, Gautam A, Wilkins B, Egan J (2012) Increase in use of non-invasive ventilation for infants with severe bronchiolitis is associated with decline in intubation rates over a decade. Intensive Care Med
Haerskjold A, Kristensen K, Kamper-Jørgensen M et al (2015) Risk factors for hospitalization for respiratory syncytial virus infection: a population-based cohort study of Danish children. Pediatr Infect Dis J 35:61–65. https://doi.org/10.1097/INF.0000000000000924
Lawrence J, Alcock D, McGrath P, Kay J, MacMurray S, Dulberg C (1993) The development of a tool to assess neonatal pain. Neonatal Netw 12:59–66
Manworren R, Hynan L (2003) Clinical validation of FLACC: preverbal patient pain face leg activity cry and consolability scale. Pediatr Nurs
Mayfield S, Bogossian F, O’Malley L, Schibler A (2014) High-flow nasal cannula oxygen therapy for infants with bronchiolitis: pilot study. J Paediatr Child Health
Metge P, Grimaldi C, Hassid S, Thomachot L, Loundou A, Martin C, Michel F (2014) Comparison of a high-flow humidified nasal cannula to nasal continuous positive airway pressure in children with acute bronchiolitis: experience in a pediatric intensive care unit. Eur J Pediatr 173:953–958. https://doi.org/10.1007/s00431-014-2275-9
Milési C, Essouri S, Pouyau R et al (2017) High flow nasal cannula (HFNC) versus nasal continuous positive airway pressure (nCPAP) for the initial respiratory management of acute viral bronchiolitis in young infants: a multicenter randomized controlled trial (TRAMONTANE study). Intensive Care Med 43:1–8. https://doi.org/10.1007/s00134-016-4617-8
Pedersen M, Vahlkvist S (2017) Comparison of CPAP and HFNC in management of bronchiolitis in infants and young children. Children. https://doi.org/10.3390/children4040028
Pham TMT, O’Malley L, Mayfield S et al (2014) The effect of high flow nasal cannula therapy on the work of breathing in infants with bronchiolitis. Pediatr Pulmonol:1–8. https://doi.org/10.1002/ppul.23060
Sarkar M, Sinha R, Roychowdhoury S, Mukhopadhyay S, Ghosh P, Dutta K, Ghosh S (2018) Comparative study between noninvasive continuous positive airway pressure and hot humidified high-flow nasal cannulae as a mode of respiratory support in infants with acute bronchiolitis in pediatric intensive care unit of a tertiary care hospital. Indian J Crit Care Med 22:85–90. https://doi.org/10.4103/ijccm.IJCCM_274_17
Sinha IP, McBride AKS, Smith R, Fernandes RM (2015) CPAP and high-flow nasal cannula oxygen in bronchiolitis. Chest
Thia LP, McKenzie SA, Blyth TP, Minasian CC, Kozlowska WJ, Carr SB (2008) Randomised controlled trial of nasal continuous positive airways pressure (CPAP) in bronchiolitis. Arch Dis Child 93:45–47. https://doi.org/10.1136/adc.2005.091231
Wood DW, Downes JJ, Lecks HI (1972) A clinical scoring system for the diagnosis of respiratory failure. Preliminary report on childhood status asthmaticus. Am J Dis Child 123:227–228
Acknowledgements
We thank OPEN, University of Southern Denmark, for statistical support.
Author information
Authors and Affiliations
Contributions
Signe Vahlkvist, Thomas Houmann Petersen, and Poul-Erik Kofoed contributed to the study conception and design. Data collection was performed by all authors. Statistical analyses were performed by Signe Vahlkvist with support from OPEN, University of Southern Denmark. The first draft of the manuscript was written by Signe Vahlkvist, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (The Regional Committee on Health Research Ethics for Southern Denmark ref. nr S-20150007) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual parents/legal guardians of participants included in the study.
Additional information
Communicated by Peter de Winter
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Vahlkvist, S., Jürgensen, L., la Cour, A. et al. High flow nasal cannula and continuous positive airway pressure therapy in treatment of viral bronchiolitis: a randomized clinical trial. Eur J Pediatr 179, 513–518 (2020). https://doi.org/10.1007/s00431-019-03533-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00431-019-03533-2