Outcomes for randomised control trials
| Author, year | Total sample size | Mortality | Findings | Adverse events | Reported limitations | Reported conclusions |
| Cam, 20029 | 37 | CPAP: 4/18 (22%) Oxygen: 0/19 (0%) | Stabilisation of patient with PaO2 >80 mm Hg after 30 min: CPAP: 14/18 (78%) Oxygen: 6/19 (32%) 13/19 oxygen patients were transitioned to CPAP after failure on oxygen, all improved | 0 (0%) | Small sample size compared with calculated sample size | Nasal CPAP is useful in improving management of acute respiratory failure in children with dengue shock syndrome |
| Chisti, 201510 | 225 | bCPAP: 3/79 (4%) Low-flow oxygen: 10/67 (15%) High-flow oxygen: 10/79 (13%) Total: 23/225 (10%) | Treatment failure: bCPAP: 5/79 (6%) Low-flow oxygen: 16/67 (24%) High-flow oxygen: 10/79 (13%) Length of hospital stay (days; median (IQR)): bCPAP: 5 (3–7) Low-flow oxygen: 4 (3–7) High-flow oxygen: 5 (3–7) | bCPAP: 17/79 (22%) Oxygen: 14/67 (21%) AEs included abdominal distension, and newly recognised heart failure. | Trial was stopped early before full recruitment | Bubble CPAP therapy could be beneficial in hospitals in developing countries where the only respiratory support is standard flow oxygen. |
| Lal, 201811 | 72 | Not reported | Decrease in RR at 1 hour (mean, SD): bCPAP: 8 (6) Supplemental oxygen via facemask or hood: 5 (4) Need for mechanical ventilation: bCPAP: 2/36 (5%) Standard of care: 1/36 (3%) | 0 (0%) | Study duration was only 1 hour, functional outcomes including need for invasive ventilation and duration of hospital stay were not evaluated | CPAP significantly decreases respiratory rate in patients with acute bronchiolitis in the first hour of treatment |
| Morales, 200415 | 26 | 0 (0%) | Duration of Hospital stay (days, mean (SD)): NIV: 8.2 (2.8) Intubation: 19 (11) Success of intervention: NIV: 12 (86%) Intubation: 12 (100%) | NIV: 11 (79%) Intubation: 11 (92%) Complications included aerophagia, erythema, septal necrosis, pericardial effusions, infections | Limitations not reported | NIV is useful in reducing the possibility of orotracheal intubation and decreases the length of hospital stay compared with mechanical ventilation |
| McCollum, 201912 | 644 | bCPAP: 53/321 (17%) Oxygen: 35/323 (11%) | Duration of respiratory support (days, mean (SD)): bCPAP: 4.5 (1.9) oxygen: 3.9 (2.1) | bCPAP: 11/321 (3%) Oxygen: 1/323 (<1%) AE included aspiration events, probable pneumothorax and skin breakdown | Trial stopped early before full recruitment, no access to radiographic imaging, designed to reflect real-world setting but staff augmented, | bCPAP in a paediatric ward without daily physician supervision did not reduce mortality among high-risk Malawian children with severe pneumonia, compared with oxygen. |
| Wilson, 201313 | 70 | Immediate CPAP: 3/31 (10%) Delayed CPAP: 0/38 (0%) | Decrease in RR at 1 hour (mean (CI)): Immediate CPAP: 16 (10, 21) Delayed CPAP: 1 (-2, 5) Percent change in RR at 2 hours: Immediate CPAP: data missing Delayed CPAP: 13 (8, 19) | Not reported | Study design not powered to evaluate mortality, Active study was only 2 hours long, not blinded, 100% consent rate, limited diagnostic testing | CPAP is a safe and effective method to decrease respiratory rates in children presenting with nonspecific respiratory distress |
| Wilson, 201714 | 2200 | CPAP: 26/995 (3%) Control: 44/1160 (4%) | Duration of CPAP (median (IQR)): CPAP: 12 (7.2–19.8) Control: 0 (0) | CPAP related AE: CPAP: 28/1021 (3%) Control: 24/1160 (2%) CPAP related AE included vomiting, nasal trauma, skin trauma, aspiration and eye trauma Other AE: CPAP: 70/1021 (7%) Control: 85/1160 (7%) Other AE included fever, cough, diarrhoea, rash, skin or mucosal complaints, respiratory distress, rhinitis, swelling, seizure, anaemia or malaria | Allocation by site rather than patient leading to concealment and enrolment bias, limited diagnostic abilities, possibly underpowered | CPAP did not decrease all-cause 2-week mortality in children 1 month to 5 years with undifferentiated respiratory distress. After adjustments for key variables, 2-week mortality in CPAP group vs control group was decreased for children under 1 year of age. CPAP improved respiratory rate. |
AE, adverse events; ; bCPAP, bubble continuous positive airway pressure; CPAP, continuous positive airway pressure; RR, respiratory rate in breaths per minute.