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Use of continuous positive airway pressure (CPAP) in acute viral bronchiolitis: A systematic review
Author(s) -
Donlan Matthew,
Fontela Patricia S.,
Puligandla Pramod S.
Publication year - 2011
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.21483
Subject(s) - medicine , continuous positive airway pressure , bronchiolitis , respiratory distress , anesthesia , intubation , randomized controlled trial , respiratory system , obstructive sleep apnea
Continuous positive airway pressure (CPAP), used either alone or associated with heliox (CPAP‐He), has become a popular therapeutic option for bronchiolitis. This systematic review assesses the impact of CPAP on endotracheal intubation, carbon dioxide pressure (PCO 2 ) and respiratory distress in patients with bronchiolitis. Methods Systematic search including studies that used CPAP or CPAP‐He in infants with bronchiolitis admitted to a PICU. Data analysis included descriptive statistics and the GRADE system. Results Five CPAP (one crossover randomized controlled trial [RCT] and four before–after studies) and three CPAP‐He (one quasi‐RCT and two before–after) studies were included. CPAP was reported to reduce PCO 2 (−6.9 to −11.7 mmHg, respectively, P < 0.015), respiratory rate (−12 to −16 breaths/min after 2 hr, P < 0.01) and the modified Wood clinical asthma score (mWCAS, −2.2 points after 1 hr, P < 0.01). CPAP‐He studies observed decreases in PCO 2 (−9.7 mmHg, P < 0.05), mWCAS (−2.12 points, P < 0.001), and respiratory rate (−8 to −13.7 breaths/min, P < 0.05) after 1 hr of treatment. Endotracheal intubation rates ranged from 0–12.5% (CPAP‐He) to 17–27% (CPAP). After applying the GRADE system, the quality of evidence for a beneficial effect of CPAP and CPAP‐He was classified as low. Conclusions The evidence supporting the use of CPAP to reduce PCO 2 and respiratory distress in bronchiolitis is of low methodological quality, and there is no conclusive evidence that CPAP reduces the need for intubation. No definitive conclusions could be drawn about the CPAP‐He effect. Further research using higher quality methodology is needed to clarify the beneficial role of these interventions. Pediatr. Pulmonol. 2011; 46:736–746. © 2011 Wiley‐Liss, Inc.