Benefits of continuous positive airway pressure (CPAP) for acute bronchiolitis

Cochrane Pre-hospital and Emergency Care

Benefits of continuous positive airway pressure (CPAP) for acute bronchiolitis

 

Source

Jat KR, Dsouza JM, Mathew JL. Continuous positive airway pressure (CPAP) for acute bronchiolitis in children. Cochrane Database of Systematic Reviews 2022, Issue 4. Art. No.: CD010473. DOI: 10.1002/14651858.CD010473.pub4

 

Background

Bronchiolitis is a common cause for pediatric emergency visits and hospitalization. There is no specific treatment for bronchiolitis, yet continuous positive airway pressure (CPAP) has been used to prevent the need for mechanical ventilation.

 

Objectives 

In patients less than three years of age with bronchiolitis, what is the efficacy and safety of CPAP compared to no CPAP?

 

Results

Compared to no CPAP, patients with CPAP had a lower respiratory rate (low certainty evidence). Mechanical ventilation, change in pCO₂, hospital stay duration did not differ between the two groups (low certainty evidence). However, time to recovery, change in arterial oxygen saturation, change in pO₂, hospital admission rate (from emergency department tohospital), duration of emergency department stay, or need for intensive care unit admission were not assessed. No side effects such as pneumothorax, local nasal effects or shock were reported but two children in the CPAP group experienced irritability (low certainty evidence).

 

Caveat

Low certainty evidence suggests a decreased respiratory rate amongst children with bronchiolitis who receive CPAP, but there is a lack of evidence favoring the use of CPAP for other outcomes. Given the low level of evidence in this review, it is highly likely that future studies will modify the results. Larger, adequately powered trials are needed to evaluate the effects of CPAP in children with acute bronchiolitis.

 

Authors

Chady El Tawil

chady.eltawil.med@ssss.gouv.qc.ca

Centre Hospitalier Affilié Universitaire Régional (CHAUR), Trois-Rivières (Québec), Canada

Montreal Children’s Hospital, Montreal (Québec), Canada