6 cmH2O Continuous Positive Airway Pressure Versus Conventional Oxygen Therapy in Severe Viral Bronchiolitis: A Randomized Trial

Objective: To compare the effects of nasal continuous positive airway pressure (nCPAP) and conventional oxygen therapy on the clinical signs of respiratory distress and the respiratory muscle workload in acute viral bronchiolitis. Design: Prospective, randomized, monocentric study carried out in the pediatric intensive care unit (PICU) of a university hospital. Patients: Infants <6 months old, admitted to the PICU with severe respiratory syncytial virus bronchiolitis. Intervention: The patients were randomized into two groups for 6 hr. The nCPAP group (n = 10) received 6 cmH(2)O pressure support delivered by a jet flow generator and the control group (n = 9) received an air/oxygen mixture from a heated humidifier. Respiratory distress was assessed by the modified Wood's clinical asthma score (m-WCAS), and inspiratory muscle work was evaluated by calculating the pressure-time product per breath (PTPinsp/breath) and per minute (PTPinsp/min) from the esophageal pressure (Pes) recordings. Measurements and Main Results: Compared with control condition, nCPAP decreased m-WCAS [-2.4 (1.05) vs. -0.5 (1.3), P = 0.03], PTPes(insp)/breath [-9.7 (5.7) vs. -1.4 (8.2), P = 0.04], PTPes(insp)/min [-666 (402) vs. -116 (352), P = 0.015], and FiO(2) [-7 (10) vs. +5 (15), P = 0.05]. Significant worsening of m-WCAS was only observed in the control group (4/9 vs. 0/10, P = 0.03). Conclusions: nCPAP rapidly decreased inspiratory work in young infants with acute bronchiolitis. Improvement in the respiratory distress score at 6 hr was proportional to the initial clinical severity, suggesting the importance of rapid nCPAP initiation in the more severe forms of the disease. Pediatr Pulmonol. 2013; 48:45-51. (C) 2012 Wiley Periodicals, Inc.