Positive end-expiratory pressure during Helmet ventilation in critically
ill bronchiolitis: a multicenter randomized clinical trial
Abstract
Objectives: To evaluate the effects of two different levels of
positive end-expiratory pressure (PEEP) during helmet continuous
positive airway pressure (HCPAP) support on the intubation rate in
infants with bronchiolitis admitted to pediatric intensive care units
(PICUs). Design: Multicentric prospective, randomized, open
clinical trial. Setting: Four tertiary PICUs in Italy.
Participants: Infants admitted to PICUs due to severe
bronchiolitis and requiring respiratory support. Interventions:
The enrolled patients were randomly assigned one of two PEEP levels for
HCPAP support: high (P10 group: 10 cmH 2O) or low (P5
group: 5 cmH 2O). Measurements and Main
Results: In total, 64 patients were randomly assigned to the P10 group,
and 60 to the P5 group. The intubation rate was 9/60 (15%) and 9/64
(14%) in P5 and P10 groups (OR 0.94, 95% CI 0.36-2.46, p=0.99). Of the
patients in the P5 group, 47 (78%) were escalated to a PEEP level of 10
cmH 2O. PEEP level was not associated to intubation rate
(OR 0.69, 95% CI 0.19 to 2.40, p=0.57), after adjustment for age,
gestational age, high flow nasal cannula application, bronchiolitis
severity score and pediatric index of mortality 3. No cases of
pneumothorax were observed in this study. Conclusions: In this
trial on infants with severe bronchiolitis, a PEEP level of 10 cm H
2O during HCPAP in comparison to an initial level of 5
cm H 2O did not show to prevent intubation. These
results are not conclusive due to the premature stopping.