Table 3

Outcomes for randomised control trials

Author, yearTotal sample sizeMortalityFindingsAdverse eventsReported limitationsReported conclusions
37CPAP: 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 sizeNasal CPAP is useful in improving management of acute respiratory failure in children with dengue shock syndrome
225bCPAP: 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 recruitmentBubble CPAP therapy could be beneficial in hospitals in developing countries where the only respiratory support is standard flow oxygen.
72Not reportedDecrease 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 evaluatedCPAP significantly decreases respiratory rate in patients with acute bronchiolitis in the first hour of treatment
260 (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 reportedNIV is useful in reducing the possibility of orotracheal intubation and decreases the length of hospital stay compared with mechanical ventilation
644bCPAP: 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.
70Immediate 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 reportedStudy design not powered to evaluate mortality, Active study was only 2 hours long, not blinded, 100% consent rate, limited diagnostic testingCPAP is a safe and effective method to decrease respiratory rates in children presenting with nonspecific respiratory distress
2200CPAP: 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 underpoweredCPAP 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.