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Continuous negative extrathoracic pressure or continuous positive airway pressure for acute hypoxemic respiratory failure in childrenShah PS, Ohlsson A, Shah JP
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SummaryObservational studies suggest continuous negative extrathoracic pressure (CNEP) might help children with acute respiratory failure and shortage of oxygen receive adequate blood oxygen, but more trials are neededSeveral treatments are used to help increase blood oxygen levels in respiratory failure and thereby reduce organ damage and the risk of death. CNEP creates a negative pressure over the chest to help it to expand and fill with more oxygen. Continuous positive airway pressure (CPAP) is the standard method, using increased pressure of the breathed air. The relative efficacy of these treatments is unclear. We found only one study that examined CNEP in children with acute respiratory failure. It may be beneficial, but there is not enough research to be sure.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 4, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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July 21. 2003 AbstractBackgroundAcute hypoxemic 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. ObjectivesTo assess the effectiveness of CNEP or Ni-CPAP in children with AHRF from non-cardiogenic causes. Search strategyWe searched the Cochrane Central Register of Controlled Trials (The Cochrane Library 2007, Issue 3); MEDLINE (January 1966 to July 2007); EMBASE (1980 to July 2007); and CINAHL (1982 to July 2007). Selection criteriaRandomized or quasi-randomized clinical trials of CNEP or Ni-CPAP versus standard therapy (including positive pressure ventilation) involving children (from 1 month old to less than 18 years of age at time of randomization) who met the criteria for diagnosis of AHRF with at least one of the outcomes reported. Data collection and analysisRisks 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 relative risk (RR) with 95% confidence intervals (CI) and risk difference (RD). Main resultsOne eligible study published in an abstract format was identified. Thirty three infants (18 controls, 15 receiving CNEP) with a clinical diagnosis of bronchiolitis and fraction of inspired oxygen (FiO2) > 40% were studied. This allowed a reduction in the FiO2 (< 30% within one hour of initiation of therapy) in four patients 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). Authors' conclusionsThere is a lack of well designed, controlled experiments of non-invasive modes of respiratory support in children with AHRF. Reduction of in-hospital mortality is an important outcome and even a small reduction would be beneficial. Studies assessing other outcomes such as avoidance of intubation and its associated complications, reduction in hospital stay and improvement in patient comfort are also valuable in gauging the overall impact of these strategies. |