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IS CONTINUOUS POSITIVE AIRWAY PRESSURE EFFECTIVE IN BRONCHIOLITIS?
A 3-month-old boy is admitted to the paediatric ward with bronchiolitis. He is initially managed with oxygen, nursing care and intravenous fluids. However, his respiratory distress worsens a few hours after admission. The senior house officer measures a capillary blood gas which shows a Pco2 of 8.7 kPa. You, the on-call registrar, review the patient and discuss the situation with the consultant. The consultant suggests that the child should be commenced on nasal continuous positive airway pressure (nCPAP). You wonder whether nCPAP in an infant with bronchiolitis would improve his clinical status and/or avoid intubation?
Clinical bottom line
There is no evidence that the use of nasal continuous positive airway pressure (nCPAP) in bronchiolitis can avoid mechanical ventilation.
Weak evidence suggests that early use of nCPAP in moderate to severe bronchiolitis might lead to limited improvement in cardiorespiratory and ventilatory parameters. (Grade C)
STRUCTURED CLINICAL QUESTION
In infants with worsening bronchiolitis [patient], does nasal continuous positive airway pressure [intervention], compared with the standard management of oxygen and supportive care [comparison], improve clinical status and/or avoid mechanical ventilation [outcome]?
SEARCH STRATEGY AND OUTCOME
MEDLINE (1966 to date) and OLDMEDLINE …