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[CPAP vs oxygen therapy in infants being transported due to acute respiratory failure]
Raquel Manso Ruiz de la Cuesta1, Pablo Del Villar Guerra2, Alberto Medina Villanueva3
1Unidad de Cuidados Intensivos Pediátricos y Neonatales, Complejo Hospitalario de Navarra, Pamplona, España.
Insights
Continuous positive airway pressure (CPAP) is a safe and effective respiratory support for infants with acute respiratory failure during transport. CPAP use during transport significantly reduced respiratory distress scores and heart rate compared to oxygen therapy.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Critical Care
Background:
- Infants with acute respiratory failure (ARF) often require interhospital transfer.
- Optimizing respiratory support during transport is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the effectiveness and safety of continuous positive airway pressure (CPAP) in infants with ARF during interhospital transfer.
- To compare outcomes in the pediatric intensive care unit (PICU) between infants receiving CPAP versus oxygen therapy during transport.
Main Methods:
- Retrospective observational study of infants (0-12 months) with ARF requiring interhospital transfer to the PICU.
- Analysis of health records comparing infants transported with CPAP versus oxygen therapy.
Main Results:
- 110 infants were included: 71 received CPAP, 39 received oxygen therapy. Acute bronchiolitis was the primary cause of ARF (81.8%).
- CPAP significantly reduced the Wood-Downes score and heart rate during transport compared to oxygen therapy.
- No intubations occurred during transport. PICU intubation rates were similar (7% CPAP vs 5.1% oxygen). Bilevel positive airway pressure was required more often in the oxygen therapy group (100% vs 69.2%).
Conclusions:
- Early CPAP administration is a safe respiratory support intervention for infants with ARF during interhospital transport.
- CPAP during transport offers superior benefits in reducing respiratory distress and heart rate compared to oxygen therapy.
- CPAP may reduce the need for escalation of respiratory support in the PICU.
Objective:
The aims of our study are to evaluate the effectiveness and security of CPAP (continuous positive airway pressure) in infants transferred with acute respiratory failure (ARF) and to compare their evolution in PICU between CPAP vs oxygen therapy.
Materials And Methods:
We conducted a retrospective observational and analytical study by reviewing the health records of infants with ARF aged 0 to 12months that required interhospital transfer to the PICU.
Results:
We included 110 patients: 71 transported with CPAP and 39 with oxygen therapy. The main cause of ARF was acute bronchiolitis (81.8%). The median level of CPAP was 7cmH2O (interquartile range, 6-7). Controlling by the previous values in specific multivariable models, CPAP produced a significant decrease in the Wood-Downes score (beta = -1.08; 95% CI = -1.76 to -0.40; P = .002) and the heart rate (beta = -19.64, 95% CI = -28.46 to -10.81; P < .001). No patients required endotracheal intubation during transport. During the PICU stay, the intubation rate was similar in the CPAP group (7%) and the oxygen therapy group (5.1%) (P=.689). The proportion of patients that required bilevel positive airway pressure within 6hours of admission to the PICU was higher in the oxygen therapy group: 100% (11/11) vs 69.2% (18/26), P=.04.
Conclusions:
Early administration of CPAP to infants with ARF was a safe respiratory support intervention during interhospital transport. During patient transport, the use of CPAP achieved greater decreases in the Wood-Downes score and heart rate compared to oxygen therapy.
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