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Research ArticleOriginal Research

Helmet Versus Nasal-Prong CPAP in Infants With Acute Bronchiolitis

Juan Mayordomo-Colunga, Corsino Rey, Alberto Medina, Pablo Martínez-Camblor, Ana Vivanco-Allende and Andrés Concha
Respiratory Care April 2018, 63 (4) 455-463; DOI: https://doi.org/10.4187/respcare.05840
Juan Mayordomo-Colunga
Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Spain.
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  • For correspondence: [email protected]
Corsino Rey
Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Spain.
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Alberto Medina
Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Spain.
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Pablo Martínez-Camblor
Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire, and with the Universidad Autónoma de Chile, Santiago, Chile.
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Ana Vivanco-Allende
Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Spain.
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Andrés Concha
Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Spain.
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Abstract

BACKGROUND: Nasal prongs are frequently used to deliver noninvasive CPAP in bronchiolitis, especially in the youngest children. A helmet interface is an alternative that might be comparable to nasal prongs. We sought to compare these interfaces.

METHODS: We performed a prospective, randomized, crossover, single-center study in an 8-bed multidisciplinary pediatric ICU in a university hospital. Infants age <3 months who were consecutively admitted to the pediatric ICU during a bronchiolitis epidemic season and fulfilled inclusion criteria were recruited. Subjects were randomly allocated to receive CPAP via a helmet or nasal prongs for 60 min. The subjects were then placed on the other CPAP system for another 60-min period (helmet then nasal prongs [H-NP] or nasal prongs then helmet [NP-H]). Measurements were taken at 30, 60, 90, and 120 min. Failure was defined as the need for further respiratory support.

RESULTS: Sixteen subjects were included, with 9 in the H-NP group and 7 in the NP-H group. CPAP significantly reduced respiratory distress, showing no differences between the H-NP and NP-H groups in terms of improving the Modified Wood's Clinical Asthma Score from 4.8 ± 1 to 3 ± 0.9 and 2.7 ± 1.7 points at 60 min and 120 min in the H-NP group, respectively, and from 4.2 ± 0.9 to 2.8 ± 0.9 and to 2.9 ± 0.9 at 60 min and 120 min, respectively, in the NP-H group. Sedatives were used in only 3 subjects (2 in the NP-H group, P = .77). The failure rate was similar in both groups (3 of 9 subjects vs 3 of 7 subjects, P = .70). No significant differences were seen for heart rate, breathing frequency, FIO2, or transcutaneous oxygen saturation response.

CONCLUSIONS: Our results suggest that CPAP delivered by nasal prongs and CPAP delivered by helmet are similar in terms of efficacy in young infants with acute bronchiolitis.

  • bronchiolitis
  • continuous positive airway pressure
  • noninvasive ventilation
  • helmet
  • nasal prongs
  • infants

Footnotes

  • Correspondence: Juan Mayordomo-Colunga MD PhD, Sección de Cuidados Intensivos Pediátricos, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, Avda. de Roma s/n 33011, Oviedo, Asturias, Spain. E-mail: jmcolunga{at}hotmail.com.
  • The authors have disclosed no conflict of interest.

  • Copyright © 2018 by Daedalus Enterprises
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Respiratory Care: 63 (4)
Respiratory Care
Vol. 63, Issue 4
1 Apr 2018
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Helmet Versus Nasal-Prong CPAP in Infants With Acute Bronchiolitis
Juan Mayordomo-Colunga, Corsino Rey, Alberto Medina, Pablo Martínez-Camblor, Ana Vivanco-Allende, Andrés Concha
Respiratory Care Apr 2018, 63 (4) 455-463; DOI: 10.4187/respcare.05840

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Helmet Versus Nasal-Prong CPAP in Infants With Acute Bronchiolitis
Juan Mayordomo-Colunga, Corsino Rey, Alberto Medina, Pablo Martínez-Camblor, Ana Vivanco-Allende, Andrés Concha
Respiratory Care Apr 2018, 63 (4) 455-463; DOI: 10.4187/respcare.05840
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Keywords

  • Bronchiolitis
  • continuous positive airway pressure
  • noninvasive ventilation
  • helmet
  • nasal prongs
  • infants

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