Continuous negative extrathoracic pressure or continuous positive airway pressure for children with acute respiratory failure and shortage of oxygen

Shah PS, Ohlsson A, Shah JP

Published Online:

September 7, 2011

Continuous negative extrathoracic pressure (CNEP) or continuous positive airway pressure (CPAP) are used to help increase blood oxygen levels in respiratory failure and thereby reduce organ damage and risk of death. However, safety and efficacy are not evaluated.

One study of CNEP included 33 participants and one study of CPAP included 37 participants. Both studies reported short-term improvements but no report of clinically significant outcomes are available. With a small number of patients in both studies, safety of either approach could not be evaluated. Both studies have methodological issues and were under-powered. No adverse events were reported in ether of the included trials. Well-designed multicentric controlled studies of adequate numbers of infants assessing clinically important outcomes are needed as we can not comment on safety of the intervention as it was not evaluated. The major limitation of this review is that it has a very small number of studies which included an even smaller sample of children.

Abstract (click to read)

Background:

Acute hypoxaemic respiratory failure (AHRF) is an important cause of mortality and morbidity in children. Positive pressure ventilation is currently the standard care, however, it does have complications. Continuous negative extrathoracic pressure ventilation (CNEP) or continuous positive airway pressure (CPAP) ventilation delivered via non-invasive approaches (Ni-CPAP) have shown certain beneficial effects in animal and uncontrolled human studies.

Objectives:

To assess the effectiveness of CNEP or Ni-CPAP in children with AHRF from non-cardiogenic causes.

Search strategy:

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 1) which contains the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (January 1966 to January week 3, 2011), EMBASE (1980 to January 2011) and CINAHL (1982 to December 2010).

Selection criteria:

Randomised or quasi-randomised clinical trials of CNEP or Ni-CPAP versus standard therapy (including positive pressure ventilation) involving children (from one month old to less than 18 years at time of randomisation) who met the criteria for diagnosis of AHRF with at least one of the outcomes reported.

Data collection and analysis:

Risks of bias of the included study was assessed using allocation concealment, blinding of intervention, completeness of follow-up and blinding of outcome measurements. Data on relevant outcomes were abstracted and the effect size was estimated by calculating risk ratio (RR) with 95% confidence intervals (CI) and risk difference (RD).

Main results:

We identified two eligible studies; one of CPAP and one of CNEP (published as an abstract). The CPAP study enrolled 37 children to oxygen mask and CPAP and reported improvement in respiratory rate and oxygen saturation in both arms after 30 minutes of application. The CNEP study was published as an abstract and included 33 infants with bronchiolitis. In the CNEP study there was a reduction in the fraction of inspired oxygen (FiO2) (< 30% within one hour of initiation of therapy) in four participants in the CNEP group compared to none in the control group (RR 10.7, 95% CI 0.6 to 183.9). One infant required CPAP and one infant required nasal CPAP in the control group while all infants in the CNEP group were managed without intubation (RR for both outcomes 0.40, 95% CI 0.02 to 9.06). No adverse events were reported in ether of the included trials.

Authors' conclusions:

There are a lack of well-designed, controlled experiments of non-invasive modes of respiratory support in children with AHRF. Studies assessing outcomes of mortality and avoidance of intubation and its associated complications, hospital stay and patient comfort are needed.

This record should be cited as:

Shah PS, Ohlsson A, Shah JP. Continuous negative extrathoracic pressure or continuous positive airway pressure compared to conventional ventilation for acute hypoxaemic respiratory failure in children. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD003699. DOI: 10.1002/14651858.CD003699.pub3

Assessed as up to date:

January 31, 2011

Find the research

Get full text at The Cochrane Library

Primary Review Group:

Acute Respiratory Infections Group

Health topics:

Infectious disease > Respiratory infections > Diagnosis & patient care

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Continuous negative extrathoracic pressure or continuous positive airway pressure for children with acute respiratory failure and shortage of oxygen

More like this

Copyright © 2012 - The Cochrane Collaboration