High-Flow Nasal Prong Oxygen Therapy or Nasopharyngeal Continuous Positive Airway Pressure for Children With Moderate-to-Severe Respiratory Distress?*

2013 ◽  
Vol 14 (7) ◽  
pp. e326-e331 ◽  
Author(s):  
Fia ten Brink ◽  
Trevor Duke ◽  
Janine Evans
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Respiratory Distress ◽  
Airway Pressure ◽  
Oxygen Therapy ◽  
Positive Airway Pressure ◽  
High Flow ◽  
Nasal Prong ◽  
Severe Respiratory Distress

Bedeutung nicht-invasiver Verfahren in der Therapie des akuten hypoxämischen Versagens bei COVID-19

Pneumologie ◽  
2021 ◽  
Author(s):  
Wolfram Windisch ◽  
Bernd Schönhofer ◽  
Daniel Sebastian Majorski ◽  
Maximilian Wollsching-Strobel ◽  
Carl-Peter Criée ◽  
...  
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Oxygen Therapy ◽  
Positive Airway Pressure ◽  
High Flow ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
High Flow Oxygen ◽  
Invasive Verfahren

ZusammenfassungIn der Corona-Pandemie werden zunehmend nicht-invasive Verfahren zur Behandlung des akuten hypoxämischen Versagens bei COVID-19 eingesetzt. Hier stehen mit der HFOT (high-flow oxygen therapy), CPAP (continuous positive airway pressure) und der NIV (non-invasive ventilation) unterschiedliche Verfahren zur Verfügung, die das Ziel einer Intubationsvermeidung verfolgen. Der aktuelle Übersichtsartikel fasst die heterogene Studienlage zusammen. Wesentlich ist die Erkenntnis, dass diese nicht-invasiven Verfahren durchaus auch bei einem schweren, akuten hypoxämischen Versagen erfolgreich sein können und damit die Intubation wie auch Tubus-assoziierte Komplikationen vermeiden können. Demgegenüber bleibt aber ebenso zu betonen, dass die prolongierte unterstützte Spontanatmung ebenfalls zu Komplikationen führt und dass demzufolge insbesondere ein spätes NIV-Versagen mit erheblich verschlechterter Prognose einhergeht, was vor dem Hintergrund weiterhin hoher NIV-Versagensraten in Deutschland bedeutsam ist. Der aktuelle Artikel verweist schließlich auch auf einen Parallelartikel in dieser Ausgabe, der die medial in der Öffentlichkeit in Deutschland geführte Debatte zu diesem Thema aufgreift und deren inhaltliche Fragwürdigkeit, aber auch die negativen Auswirkungen auf die Gesellschaft und die Fachwelt adressiert. Gleichzeitig wird die Bedeutung von regelmäßig zu überarbeitenden Leitlinien untermauert.

scholarly journals The Use of Bubble CPAP and Humidified High Flow Nasal Cannula Oxygen Therapy in Children with Severe Pneumonia and Hypoxemia: A Systematic Review of the Evidence

2015 ◽  
Vol 2 (2) ◽  
pp. 71-78
Author(s):  
Mohammod Jobayer Chisti ◽  
Trevor Duke ◽  
Tahmeed Ahmed ◽  
KM Shahunja ◽  
Abu SMSB Shahid ◽  
...  
Keyword(s):  
Respiratory Distress ◽  
Airway Pressure ◽  
Oxygen Therapy ◽  
Positive Airway Pressure ◽  
Severe Pneumonia ◽  
High Flow ◽  
Low Flow ◽  
Older Children ◽  
High Flow Nasal Cannula ◽  
Bubble Cpap

Background: Among children with severe pneumonia hypoxemia is the commonest complication leading to death. Some children will have both type I (hypoxemic) and type II (hypercarbic) respiratory failure. Together this accounts for high case-fatality rates in most populations with severe pneumonia. Standard oxygen supplementation by nasal prongs (low flow) can be lifesaving, but is not always sufficient to manage respiratory failure. In recent years continuous positive airway pressure (CPAP) has been used to relieve hypoxemia and reduce the work of breathing. There are several ways to give positive airway pressure; one is bubble CPAP (BCPAP), another is high flow nasal cannula (HFNC) oxygen therapy.Objective: To review the evidence for using BCPAP, and HFNC therapy in children with severe pneumonia and hypoxemia, particularly the experience of these therapies in developing countries.Methods: Two of our study investigators independently conducted searches of the existing literature in PUBMED in October 2014 to identify reports focusing on the use of BCPAP or HFNC therapy in children with severe pneumonia and hypoxemia, as defined by the World Health Organization.Results: 13 relevant studies were identified. Ten evaluated the efficacy of BCPAP among 3164 children, and three described the same for HFNC in 255 children. In all studies the entry criteria was severe respiratory distress. The study methodologies, the outcomes recorded and results were heterogeneous. The age range of the children in the studies was from the immediate newborn period on day 1 of life up to the age of 12 years. However, we evaluated the outcome of our review in two aged categories and found: children 0-28 days for 8 studies and > 28 days for 2 studies. In 3 studies of children aged 0-28 days and 2 studies of older children had clinical features consistent with severe pneumonia and those who among them were treated with immediate BCPAP therapy had better outcome (p<0.01 or CI < 1) compared to those who were treated with delayed BCPAP, or historical control one each, or standard flow flow (LF) oxygen therapy (in two studies). Primary outcomes were comparable between BCPAP and ventilator driven CPAP in three studies and between BCPAP and low flow oxygen or variable flow nasal CPAP in two studies (95% CI contain 1) of children aged 0-28 days. Children treated with HFNC compared to those who did not receive HFNC in three relevant studies, all of them in older children had better outcome (p<0.05).Conclusion: Studies of BCPAP and HFNC are heterogeneous with different populations, comparators, outcome measures and results. However limited studies suggest that BCPAP may be effective in managing respiratory distress and hypoxemia in developing countries, although evidence is not overwhelming. Studies of the use of HFNC therapy are more limited and do not allow firm conclusions to be made. Most studies of BCPAP and HFNC have been done in neonates with respiratory distress, and studies outside this age group, where the predominant pathologies are bacterial pneumonia, sepsis and viral bronchiolitis are needed.Bangladesh Crit Care J September 2014; 2 (2): 71-78

scholarly journals Continuous positive airway pressure (CPAP) to treat respiratory distress in newborns in low- and middle-income countries

2016 ◽  
Vol 47 (1) ◽  
pp. 19-22 ◽  
Author(s):  
Juan Emmanuel Dewez ◽  
Nynke van den Broek
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Respiratory Distress ◽  
Airway Pressure ◽  
Large Scale ◽  
Positive Airway Pressure ◽  
Severe Respiratory Distress ◽  
Middle Income ◽  
Mortality And Morbidity ◽  
Middle Income Countries ◽  
Low And Middle Income

Severe respiratory distress is a serious complication common to the three major causes of neonatal mortality and morbidity (prematurity, intra-partum-related hypoxia and infections). In low- and middle-income countries (LMICs), 20% of babies presenting with severe respiratory distress die. Continuous positive airway pressure (CPAP), is an effective intervention for respiratory distress in newborns and widely used in high-income countries. Following the development of simple, safe and relatively inexpensive CPAP devices, there is potential for large-scale implementation in the developing world. In this article, we describe existing CPAP systems and present a review of the current literature examining the effectiveness of CPAP compared to standard care (oxygen) in newborns with respiratory distress. We also discuss the evidence gap which needs to be addressed prior to its integration into health systems in LMICs.

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