Infants with severe respiratory syncytial virus needed less ventilator time with nasal continuous airways pressure then invasive mechanical ventilation

Aim Nasal continuous positive airway pressure ( NCPAP ) has been proposed as an early first‐line support for infants with severe respiratory syncytial virus ( RSV ) infection. We hypothesised that infants <6 months with severe RSV would require shorter ventilator support on NCPAP than invasive mechanical ventilation ( IMV ). Methods Retrospective cohort analysis of infants admitted to two paediatric intensive care units, one primarily using NCPAP and one exclusively using IMV , between J anuary 2008 and F ebruary 2010. Results We studied 133 ( NCPAP n = 89, IMV n = 46) consecutively admitted infants. On admission, disease severity [i.e. P aediatric RISk of M ortality ( PRISM ) II score ( NCPAP 5.1 ± 2.8 vs. IMV 12.2 ± 6.0, p < 0.001) and SpO 2 / F i O 2 ratio ( NCPAP 309 ± 81 vs. IMV 135 ± 98, p   <   0.001)] was higher in the IMV group. NCPAP remained independently associated with shorter ventilatory support (hazard ratio 2.3, 95% CI 1.1–4.7, p   =   0.022) after adjusting for PRISM II score, PCO 2 , SpO 2 / F i O 2 ratio, bronchopulmonary dysplasia and occurrence of clinically suspected secondary bacterial pneumonia. Conclusion Nasal continuous positive airway pressure was independently associated with a shorter duration of ventilatory support. Differences in baseline disease severity mandate a randomised trial before the routine use of NCPAP can be recommended.