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You are asked to see a 2-month-old boy who has been ill for 3 days. He has respiratory syncytial virus positive bronchiolitis and is needing 1.5 L/min oxygen by low flow. His capillary blood gas has pH 7.26 pCO2 9.9 kPa pO2 4.5 kPa and base excess −5.0. His respiratory rate is 60 and increasing. The family has been told he may need moving to 40 miles to the regional paediatric intensive care unit (PICU). They are worried and angry, not least because his sister is delivering a baby upstairs.
You wonder whether starting continuous positive airway pressure (CPAP) will reduce the need for ventilation and help keep them together.
Structured clinical question
In an infant less than 2 years old with bronchiolitis will early use of CPAP reduce the need for intubation and ventilation?
Medline, CINAHL and EMbase …
Contributors JF wrote the question, performed the literature search and wrote the article. RT inspired the idea and devised the clinical question. AS assisted with the literature search and in designing the clinical question.
Competing interests None.
Provenance and peer review Not commissioned; internally peer reviewed.