CPAP associated with low treatment failure than High-Flow Nasal Cannula in acute bronchitis

A new study published in BMC Pediatrics highlights the danger of intrusive mechanical ventilation in children and also found that Continuous Positive Air Pressure (CPAP) results in lesser treatment failure than High-Flow Nasal Cannula (HFNC). 

With a prevalence of 1 in 10 infants in the first year, bronchiolitis is the most prevalent respiratory illness in children and the leading reason for pediatric hospitalization globally. Both the HFNC and the CPAP are high flow systems that may produce positive end expiratory pressure. HFNC reduces resistance and dead space in the upper airways. Compared to CPAP, HFNC is thought to be less invasive, easier to manage, and better tolerated by patients.

High-Flow Nasal Cannula are being used more often outside of pediatric critical care units. Given this tendency, it is essential to update the current data and evaluate the published literature in order to determine if HFNC is more effective than CPAP in treating children with bronchiolitis. The government and health insurers will be able to establish clinical practice recommendations more effectively with the use of this information.

LILACS, COCHRANE, MEDLINE, and EMBASE From the beginning through June 2022, clinical trials databases were examined for relevant and gray literature. Randomized clinical trials (RCTs) that included kids under 2 with acute, moderate, or severe bronchiolitis served as the inclusion criterion for the literature. Two reviewers independently choose all of the studies and extract the data.

The key findings of this study were:

106 records were found in the initial searches. 

The meta-analysis only included five randomized controlled trials that satisfied the inclusion requirements. 

In the CPAP group and the HFNC group, the risk of invasive mechanical ventilation was not statistically different (very low quality). 

Compared to the HFNC group, the CPAP group had a considerably lower probability of treatment failure (very low quality).

In conclusion, there was probably no discernible difference in the risk of invasive mechanical breathing between HFNC and CPAP. With the highest risk of mild adverse effects, CPAP lowers the probability of therapeutic failure. To verify these findings, more studies are required.

Reference:

Buendía, J. A., Feliciano-Alfonso, J. E., & Laverde, M. F. (2022). Systematic review and meta-analysis of efficacy and safety of continuous positive airways pressure versus high flow oxygen cannula in acute bronchiolitis. In BMC Pediatrics (Vol. 22, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12887-022-03754-9