Aim Bronchiolitis is a common respiratory illness in childhood with 64 million cases of RSV bronchiolitis worldwide every year. In England, 2.8% hospital admissions in children <1 year of age are due to RSV bronchiolitis with upto 5% of these patients going on to develop respiratory failure.
The Aim of this study was to review the use of nasal continuous positive airway pressure (nCPAP) in infants with bronchiolitis. A secondary aim was to identify predictive factors for CPAP failure resulting in endotracheal intubation and mechanical ventilation
Methods A prospective, multicentre, observational study was undertaken from 1November 2008 to 28February 2009. Seven Paediatric Units in the South of England participated in the study. Data was collected on indications for nCPAP, respiratory rate and blood gases prior to nCPAP, total number of days on nCPAP and length of hospital stay.
Results A total of 51 infants with the clinical diagnosis of bronchiolitis required nCPAP during the study period. The main indications were increased work of breathing (47.0%), apnoeas (39.2%) and increasing oxygen requirements (23.5%). Among them 16 were ex-preterm (31.37%). Prior to nCPAP the mean respiratory rate was 63/min(range 28 to 120), mean oxygen saturations 85%(70 to 98%), mean pH 7.25(7.03 to 7.36) and mean PCO2 10.42(4.36 to 19.0). The average time on nCPAP was 2.6 days(2 hours to 11 days) and the average length of hospital stay was 10.96 days(5 to 22 days). There were no reported dealths. 11 out of the 51 infants failed trial on nCPAP requiring intubation (21.5%). The main indications were apnoeas (45.45%), CO2 retention (36.36%) and increasing work of breathing (36.36%). Subgroup analysis revealed that 7 out of the 11 infants requiring intubation were ex-preterm (63.6%) and 8 had significant PCO2 rise (>8) prior to the trial of nCPAP (72.72%).
Conclusions nCPAP has a good success rate in bronchiolitis. In our study, predictive factors associated with nCPAP failure were prematurity and high CO2 retention prior to trial of nCPAP. The authors recommend the availability of nCPAP facilities in all paediatric units and appropriate training of medical and nursing staff in its optimal use.
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