Neil Fernandes, MD,
Pediatric Intensivist
Marshfield Children's Hospital
Marshfield, Wisconsin
Disclosure information not submitted.
Michael Salt, DO
Pediatric Intensivist
Tufts Medical Center
Boston, Massachusetts, United States
Disclosure information not submitted.
Ryan Carroll, MD, MPH
Pediatric Intensivist
Massachusetts General Hospital for Children, United States
Disclosure information not submitted.
Title: CPAP vs. HFNC: A survey of practice for bronchiolitis
INTRODUCTION: Bronchiolitis is the most common cause of admission in children under 2 years of age in the United States. Continuous positive airway pressure (CPAP) and high-flow nasal cannula therapy (HFNC) have been used to provide non-invasive respiratory support in children, but there is limited evidence for best practices. Our study aims to describe current practices and clinician preferences relating to use of non-invasive (NIV) respiratory support (CPAP and HFNC) in the management of bronchiolitis.
Methods: We performed a cross-sectional web-based survey of members of the ‘Pediatric Acute Lung Injury and Sepsis Investigators’ group. The survey consisted of questions related to availability of NIV support; clinical thresholds for initiation; and clinician preferences regarding first-line support modality.
Results: The survey received 65 responses of which 63 were complete and included for analysis. The majority of the respondents (43%) were clinicians who were 1-10 years out of fellowship/residency training. All respondent’s institutions included a pediatric ICU with ability to provide HFNC and majority were able to provide CPAP (95%). Seventy-three percent had some form of bronchiolitis management pathway with a majority using some form of bronchiolitis scoring system (60%). On questions pertaining to HFNC, most respondents stated they used HFNC as an alternate to CPAP (79%) or as a method of weaning from CPAP (74%). With respect to CPAP, nasal mask and full-face mask (82%) were the most commonly used interfaces, followed by RAM cannula and oro-nasal mask (75%). Respondents were more likely to use HFNC than CPAP for children with increased work of breathing (98% vs. 97%) and were more likely to use CPAP than HFNC for children with risk factors (62% vs. 57%). Most providers considered switching from CPAP to BiPAP when more than 10 cmH2O pressure was needed; and consider intubation when IPAP/EPAP settings reach 20 (16-20)/10 (8-10) cmH2O.
Conclusions: This study aims to capture the wide variability in bronchiolitis management between clinicians and institutions. Our study shows that there is no uniform scoring system for bronchiolitis, neither a uniform clinical pathway. More studies are needed to determine optimal NIV use in children with bronchiolitis.