Physiological effects of standard oxygen therapy, high-flow nasal cannula, and helmet CPAP in acute bronchiolitis: a randomized cross-over study

Objectives Acute viral bronchiolitis (AVB) is a major cause of hospitalization for children in developed and developing countries. Nasal high flow (NHF) therapy improves oxygenation and reduces respiratory drive by enhancing carbon dioxide wash-out. However, little is known about the physiological e...
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Autor*in:	Chidini, Giovanna [verfasserIn] Mauri, Tommaso Conti, Giorgio Catenacci, Stefano Scalia Marchesi, Tiziana Dona, Giada Figini, Maria Adele Babini, Giovanni Calderini, Edoardo

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2023

Schlagwörter:	Non-invasive ventilation High-flow nasal cannulas Bronchiolitis

Anmerkung:	© The Author(s) 2023

Übergeordnetes Werk:	Enthalten in: Intensive Care Medicine – Paediatric and Neonatal - Springer International Publishing, 2023, 1(2023), 1 vom: 03. Aug.
Übergeordnetes Werk:	volume:1 ; year:2023 ; number:1 ; day:03 ; month:08

Links:	Volltext

DOI / URN:	10.1007/s44253-023-00013-2

Katalog-ID:	SPR05263700X

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520			\|a Objectives Acute viral bronchiolitis (AVB) is a major cause of hospitalization for children in developed and developing countries. Nasal high flow (NHF) therapy improves oxygenation and reduces respiratory drive by enhancing carbon dioxide wash-out. However, little is known about the physiological effects of non-invasive helmet continuous positive airway pressure (h-CPAP) and NHF on respiratory work of breathing (WOB) in pediatric patients with AVB. The present study measured esophageal pressure time product over 1 min (PTPes$ min^{−1} $), as a close surrogate for WOB during standard oxygen therapy (SOT), NHF delivered at incremental flow rates, and h-CPAP in hospitalized patients with AVB. Methods This is a physiological randomized crossover study with four 20-min steps: SOT delivered by a Venturi mask; NHF2 set at 2L/kg$ min^{−1} $PBW; NHF3 set at 3L/kg$ min^{−1} $PBW; and h-CPAP with PEEP 7 $ cmH_{2} $O. PTPes $ min^{−1} $, pressure rate product (PRP), respiratory and other physiological parameters were collected towards the end of each step. Results Ten hypoxemic children with AVB were enrolled. PTPes*$ min^{−1} $, respiratory rate (RR), PRP, and heart rate (HR) decreased progressively from h-CPAP to NHF3, NHF2, and SOT (p < 0.01). Transcutaneous carbon dioxide tension ($ tcCO_{2} $) was lower during h-CPAP, NHF3, and NHF2 than during SOT (p < 0.001). $ SpO_{2} $:$ FiO_{2} $ was higher during h-CPAP than with all other support (p < 0.01). Conclusions In pediatric patients with AVB, h-CPAP was associated with lower WOB, better oxygenation, and lower $ tcCO_{2} $ than with SOT and NHF trials. Trial registration Clinicaltrials.gov NCT03689686 Registered 1 August 2018.
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700	1		\|a Mauri, Tommaso \|4 aut
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700	1		\|a Babini, Giovanni \|4 aut
700	1		\|a Calderini, Edoardo \|4 aut
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allfields	10.1007/s44253-023-00013-2 doi (DE-627)SPR05263700X (SPR)s44253-023-00013-2-e DE-627 ger DE-627 rakwb eng Chidini, Giovanna verfasserin (orcid)0000-0002-3807-1184 aut Physiological effects of standard oxygen therapy, high-flow nasal cannula, and helmet CPAP in acute bronchiolitis: a randomized cross-over study 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2023 Objectives Acute viral bronchiolitis (AVB) is a major cause of hospitalization for children in developed and developing countries. Nasal high flow (NHF) therapy improves oxygenation and reduces respiratory drive by enhancing carbon dioxide wash-out. However, little is known about the physiological effects of non-invasive helmet continuous positive airway pressure (h-CPAP) and NHF on respiratory work of breathing (WOB) in pediatric patients with AVB. The present study measured esophageal pressure time product over 1 min (PTPes$ min^{−1} $), as a close surrogate for WOB during standard oxygen therapy (SOT), NHF delivered at incremental flow rates, and h-CPAP in hospitalized patients with AVB. Methods This is a physiological randomized crossover study with four 20-min steps: SOT delivered by a Venturi mask; NHF2 set at 2L/kg$ min^{−1} $PBW; NHF3 set at 3L/kg$ min^{−1} $PBW; and h-CPAP with PEEP 7 $ cmH_{2} $O. PTPes $ min^{−1} $, pressure rate product (PRP), respiratory and other physiological parameters were collected towards the end of each step. Results Ten hypoxemic children with AVB were enrolled. PTPes*$ min^{−1} $, respiratory rate (RR), PRP, and heart rate (HR) decreased progressively from h-CPAP to NHF3, NHF2, and SOT (p < 0.01). Transcutaneous carbon dioxide tension ($ tcCO_{2} $) was lower during h-CPAP, NHF3, and NHF2 than during SOT (p < 0.001). $ SpO_{2} $:$ FiO_{2} $ was higher during h-CPAP than with all other support (p < 0.01). Conclusions In pediatric patients with AVB, h-CPAP was associated with lower WOB, better oxygenation, and lower $ tcCO_{2} $ than with SOT and NHF trials. Trial registration Clinicaltrials.gov NCT03689686 Registered 1 August 2018. Non-invasive ventilation (dpeaa)DE-He213 High-flow nasal cannulas (dpeaa)DE-He213 Bronchiolitis (dpeaa)DE-He213 Mauri, Tommaso aut Conti, Giorgio aut Catenacci, Stefano Scalia aut Marchesi, Tiziana aut Dona, Giada aut Figini, Maria Adele aut Babini, Giovanni aut Calderini, Edoardo aut Enthalten in Intensive Care Medicine – Paediatric and Neonatal Springer International Publishing, 2023 1(2023), 1 vom: 03. Aug. (DE-627)1839534869 2731-944X nnns volume:1 year:2023 number:1 day:03 month:08 https://dx.doi.org/10.1007/s44253-023-00013-2 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 1 2023 1 03 08
spelling	10.1007/s44253-023-00013-2 doi (DE-627)SPR05263700X (SPR)s44253-023-00013-2-e DE-627 ger DE-627 rakwb eng Chidini, Giovanna verfasserin (orcid)0000-0002-3807-1184 aut Physiological effects of standard oxygen therapy, high-flow nasal cannula, and helmet CPAP in acute bronchiolitis: a randomized cross-over study 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2023 Objectives Acute viral bronchiolitis (AVB) is a major cause of hospitalization for children in developed and developing countries. Nasal high flow (NHF) therapy improves oxygenation and reduces respiratory drive by enhancing carbon dioxide wash-out. However, little is known about the physiological effects of non-invasive helmet continuous positive airway pressure (h-CPAP) and NHF on respiratory work of breathing (WOB) in pediatric patients with AVB. The present study measured esophageal pressure time product over 1 min (PTPes$ min^{−1} $), as a close surrogate for WOB during standard oxygen therapy (SOT), NHF delivered at incremental flow rates, and h-CPAP in hospitalized patients with AVB. Methods This is a physiological randomized crossover study with four 20-min steps: SOT delivered by a Venturi mask; NHF2 set at 2L/kg$ min^{−1} $PBW; NHF3 set at 3L/kg$ min^{−1} $PBW; and h-CPAP with PEEP 7 $ cmH_{2} $O. PTPes $ min^{−1} $, pressure rate product (PRP), respiratory and other physiological parameters were collected towards the end of each step. Results Ten hypoxemic children with AVB were enrolled. PTPes*$ min^{−1} $, respiratory rate (RR), PRP, and heart rate (HR) decreased progressively from h-CPAP to NHF3, NHF2, and SOT (p < 0.01). Transcutaneous carbon dioxide tension ($ tcCO_{2} $) was lower during h-CPAP, NHF3, and NHF2 than during SOT (p < 0.001). $ SpO_{2} $:$ FiO_{2} $ was higher during h-CPAP than with all other support (p < 0.01). Conclusions In pediatric patients with AVB, h-CPAP was associated with lower WOB, better oxygenation, and lower $ tcCO_{2} $ than with SOT and NHF trials. Trial registration Clinicaltrials.gov NCT03689686 Registered 1 August 2018. Non-invasive ventilation (dpeaa)DE-He213 High-flow nasal cannulas (dpeaa)DE-He213 Bronchiolitis (dpeaa)DE-He213 Mauri, Tommaso aut Conti, Giorgio aut Catenacci, Stefano Scalia aut Marchesi, Tiziana aut Dona, Giada aut Figini, Maria Adele aut Babini, Giovanni aut Calderini, Edoardo aut Enthalten in Intensive Care Medicine – Paediatric and Neonatal Springer International Publishing, 2023 1(2023), 1 vom: 03. Aug. (DE-627)1839534869 2731-944X nnns volume:1 year:2023 number:1 day:03 month:08 https://dx.doi.org/10.1007/s44253-023-00013-2 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 1 2023 1 03 08
allfields_unstemmed	10.1007/s44253-023-00013-2 doi (DE-627)SPR05263700X (SPR)s44253-023-00013-2-e DE-627 ger DE-627 rakwb eng Chidini, Giovanna verfasserin (orcid)0000-0002-3807-1184 aut Physiological effects of standard oxygen therapy, high-flow nasal cannula, and helmet CPAP in acute bronchiolitis: a randomized cross-over study 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2023 Objectives Acute viral bronchiolitis (AVB) is a major cause of hospitalization for children in developed and developing countries. Nasal high flow (NHF) therapy improves oxygenation and reduces respiratory drive by enhancing carbon dioxide wash-out. However, little is known about the physiological effects of non-invasive helmet continuous positive airway pressure (h-CPAP) and NHF on respiratory work of breathing (WOB) in pediatric patients with AVB. The present study measured esophageal pressure time product over 1 min (PTPes$ min^{−1} $), as a close surrogate for WOB during standard oxygen therapy (SOT), NHF delivered at incremental flow rates, and h-CPAP in hospitalized patients with AVB. Methods This is a physiological randomized crossover study with four 20-min steps: SOT delivered by a Venturi mask; NHF2 set at 2L/kg$ min^{−1} $PBW; NHF3 set at 3L/kg$ min^{−1} $PBW; and h-CPAP with PEEP 7 $ cmH_{2} $O. PTPes $ min^{−1} $, pressure rate product (PRP), respiratory and other physiological parameters were collected towards the end of each step. Results Ten hypoxemic children with AVB were enrolled. PTPes*$ min^{−1} $, respiratory rate (RR), PRP, and heart rate (HR) decreased progressively from h-CPAP to NHF3, NHF2, and SOT (p < 0.01). Transcutaneous carbon dioxide tension ($ tcCO_{2} $) was lower during h-CPAP, NHF3, and NHF2 than during SOT (p < 0.001). $ SpO_{2} $:$ FiO_{2} $ was higher during h-CPAP than with all other support (p < 0.01). Conclusions In pediatric patients with AVB, h-CPAP was associated with lower WOB, better oxygenation, and lower $ tcCO_{2} $ than with SOT and NHF trials. Trial registration Clinicaltrials.gov NCT03689686 Registered 1 August 2018. Non-invasive ventilation (dpeaa)DE-He213 High-flow nasal cannulas (dpeaa)DE-He213 Bronchiolitis (dpeaa)DE-He213 Mauri, Tommaso aut Conti, Giorgio aut Catenacci, Stefano Scalia aut Marchesi, Tiziana aut Dona, Giada aut Figini, Maria Adele aut Babini, Giovanni aut Calderini, Edoardo aut Enthalten in Intensive Care Medicine – Paediatric and Neonatal Springer International Publishing, 2023 1(2023), 1 vom: 03. Aug. (DE-627)1839534869 2731-944X nnns volume:1 year:2023 number:1 day:03 month:08 https://dx.doi.org/10.1007/s44253-023-00013-2 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 1 2023 1 03 08
allfieldsGer	10.1007/s44253-023-00013-2 doi (DE-627)SPR05263700X (SPR)s44253-023-00013-2-e DE-627 ger DE-627 rakwb eng Chidini, Giovanna verfasserin (orcid)0000-0002-3807-1184 aut Physiological effects of standard oxygen therapy, high-flow nasal cannula, and helmet CPAP in acute bronchiolitis: a randomized cross-over study 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2023 Objectives Acute viral bronchiolitis (AVB) is a major cause of hospitalization for children in developed and developing countries. Nasal high flow (NHF) therapy improves oxygenation and reduces respiratory drive by enhancing carbon dioxide wash-out. However, little is known about the physiological effects of non-invasive helmet continuous positive airway pressure (h-CPAP) and NHF on respiratory work of breathing (WOB) in pediatric patients with AVB. The present study measured esophageal pressure time product over 1 min (PTPes$ min^{−1} $), as a close surrogate for WOB during standard oxygen therapy (SOT), NHF delivered at incremental flow rates, and h-CPAP in hospitalized patients with AVB. Methods This is a physiological randomized crossover study with four 20-min steps: SOT delivered by a Venturi mask; NHF2 set at 2L/kg$ min^{−1} $PBW; NHF3 set at 3L/kg$ min^{−1} $PBW; and h-CPAP with PEEP 7 $ cmH_{2} $O. PTPes $ min^{−1} $, pressure rate product (PRP), respiratory and other physiological parameters were collected towards the end of each step. Results Ten hypoxemic children with AVB were enrolled. PTPes*$ min^{−1} $, respiratory rate (RR), PRP, and heart rate (HR) decreased progressively from h-CPAP to NHF3, NHF2, and SOT (p < 0.01). Transcutaneous carbon dioxide tension ($ tcCO_{2} $) was lower during h-CPAP, NHF3, and NHF2 than during SOT (p < 0.001). $ SpO_{2} $:$ FiO_{2} $ was higher during h-CPAP than with all other support (p < 0.01). Conclusions In pediatric patients with AVB, h-CPAP was associated with lower WOB, better oxygenation, and lower $ tcCO_{2} $ than with SOT and NHF trials. Trial registration Clinicaltrials.gov NCT03689686 Registered 1 August 2018. Non-invasive ventilation (dpeaa)DE-He213 High-flow nasal cannulas (dpeaa)DE-He213 Bronchiolitis (dpeaa)DE-He213 Mauri, Tommaso aut Conti, Giorgio aut Catenacci, Stefano Scalia aut Marchesi, Tiziana aut Dona, Giada aut Figini, Maria Adele aut Babini, Giovanni aut Calderini, Edoardo aut Enthalten in Intensive Care Medicine – Paediatric and Neonatal Springer International Publishing, 2023 1(2023), 1 vom: 03. Aug. (DE-627)1839534869 2731-944X nnns volume:1 year:2023 number:1 day:03 month:08 https://dx.doi.org/10.1007/s44253-023-00013-2 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 1 2023 1 03 08
allfieldsSound	10.1007/s44253-023-00013-2 doi (DE-627)SPR05263700X (SPR)s44253-023-00013-2-e DE-627 ger DE-627 rakwb eng Chidini, Giovanna verfasserin (orcid)0000-0002-3807-1184 aut Physiological effects of standard oxygen therapy, high-flow nasal cannula, and helmet CPAP in acute bronchiolitis: a randomized cross-over study 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2023 Objectives Acute viral bronchiolitis (AVB) is a major cause of hospitalization for children in developed and developing countries. Nasal high flow (NHF) therapy improves oxygenation and reduces respiratory drive by enhancing carbon dioxide wash-out. However, little is known about the physiological effects of non-invasive helmet continuous positive airway pressure (h-CPAP) and NHF on respiratory work of breathing (WOB) in pediatric patients with AVB. The present study measured esophageal pressure time product over 1 min (PTPes$ min^{−1} $), as a close surrogate for WOB during standard oxygen therapy (SOT), NHF delivered at incremental flow rates, and h-CPAP in hospitalized patients with AVB. Methods This is a physiological randomized crossover study with four 20-min steps: SOT delivered by a Venturi mask; NHF2 set at 2L/kg$ min^{−1} $PBW; NHF3 set at 3L/kg$ min^{−1} $PBW; and h-CPAP with PEEP 7 $ cmH_{2} $O. PTPes $ min^{−1} $, pressure rate product (PRP), respiratory and other physiological parameters were collected towards the end of each step. Results Ten hypoxemic children with AVB were enrolled. PTPes*$ min^{−1} $, respiratory rate (RR), PRP, and heart rate (HR) decreased progressively from h-CPAP to NHF3, NHF2, and SOT (p < 0.01). Transcutaneous carbon dioxide tension ($ tcCO_{2} $) was lower during h-CPAP, NHF3, and NHF2 than during SOT (p < 0.001). $ SpO_{2} $:$ FiO_{2} $ was higher during h-CPAP than with all other support (p < 0.01). Conclusions In pediatric patients with AVB, h-CPAP was associated with lower WOB, better oxygenation, and lower $ tcCO_{2} $ than with SOT and NHF trials. Trial registration Clinicaltrials.gov NCT03689686 Registered 1 August 2018. Non-invasive ventilation (dpeaa)DE-He213 High-flow nasal cannulas (dpeaa)DE-He213 Bronchiolitis (dpeaa)DE-He213 Mauri, Tommaso aut Conti, Giorgio aut Catenacci, Stefano Scalia aut Marchesi, Tiziana aut Dona, Giada aut Figini, Maria Adele aut Babini, Giovanni aut Calderini, Edoardo aut Enthalten in Intensive Care Medicine – Paediatric and Neonatal Springer International Publishing, 2023 1(2023), 1 vom: 03. Aug. (DE-627)1839534869 2731-944X nnns volume:1 year:2023 number:1 day:03 month:08 https://dx.doi.org/10.1007/s44253-023-00013-2 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 1 2023 1 03 08
language	English
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author	Chidini, Giovanna
spellingShingle	Chidini, Giovanna misc Non-invasive ventilation misc High-flow nasal cannulas misc Bronchiolitis Physiological effects of standard oxygen therapy, high-flow nasal cannula, and helmet CPAP in acute bronchiolitis: a randomized cross-over study
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topic_title	Physiological effects of standard oxygen therapy, high-flow nasal cannula, and helmet CPAP in acute bronchiolitis: a randomized cross-over study Non-invasive ventilation (dpeaa)DE-He213 High-flow nasal cannulas (dpeaa)DE-He213 Bronchiolitis (dpeaa)DE-He213
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author_browse	Chidini, Giovanna Mauri, Tommaso Conti, Giorgio Catenacci, Stefano Scalia Marchesi, Tiziana Dona, Giada Figini, Maria Adele Babini, Giovanni Calderini, Edoardo
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title_sort	physiological effects of standard oxygen therapy, high-flow nasal cannula, and helmet cpap in acute bronchiolitis: a randomized cross-over study
title_auth	Physiological effects of standard oxygen therapy, high-flow nasal cannula, and helmet CPAP in acute bronchiolitis: a randomized cross-over study
abstract	Objectives Acute viral bronchiolitis (AVB) is a major cause of hospitalization for children in developed and developing countries. Nasal high flow (NHF) therapy improves oxygenation and reduces respiratory drive by enhancing carbon dioxide wash-out. However, little is known about the physiological effects of non-invasive helmet continuous positive airway pressure (h-CPAP) and NHF on respiratory work of breathing (WOB) in pediatric patients with AVB. The present study measured esophageal pressure time product over 1 min (PTPes$ min^{−1} $), as a close surrogate for WOB during standard oxygen therapy (SOT), NHF delivered at incremental flow rates, and h-CPAP in hospitalized patients with AVB. Methods This is a physiological randomized crossover study with four 20-min steps: SOT delivered by a Venturi mask; NHF2 set at 2L/kg$ min^{−1} $PBW; NHF3 set at 3L/kg$ min^{−1} $PBW; and h-CPAP with PEEP 7 $ cmH_{2} $O. PTPes $ min^{−1} $, pressure rate product (PRP), respiratory and other physiological parameters were collected towards the end of each step. Results Ten hypoxemic children with AVB were enrolled. PTPes*$ min^{−1} $, respiratory rate (RR), PRP, and heart rate (HR) decreased progressively from h-CPAP to NHF3, NHF2, and SOT (p < 0.01). Transcutaneous carbon dioxide tension ($ tcCO_{2} $) was lower during h-CPAP, NHF3, and NHF2 than during SOT (p < 0.001). $ SpO_{2} $:$ FiO_{2} $ was higher during h-CPAP than with all other support (p < 0.01). Conclusions In pediatric patients with AVB, h-CPAP was associated with lower WOB, better oxygenation, and lower $ tcCO_{2} $ than with SOT and NHF trials. Trial registration Clinicaltrials.gov NCT03689686 Registered 1 August 2018. © The Author(s) 2023
abstractGer	Objectives Acute viral bronchiolitis (AVB) is a major cause of hospitalization for children in developed and developing countries. Nasal high flow (NHF) therapy improves oxygenation and reduces respiratory drive by enhancing carbon dioxide wash-out. However, little is known about the physiological effects of non-invasive helmet continuous positive airway pressure (h-CPAP) and NHF on respiratory work of breathing (WOB) in pediatric patients with AVB. The present study measured esophageal pressure time product over 1 min (PTPes$ min^{−1} $), as a close surrogate for WOB during standard oxygen therapy (SOT), NHF delivered at incremental flow rates, and h-CPAP in hospitalized patients with AVB. Methods This is a physiological randomized crossover study with four 20-min steps: SOT delivered by a Venturi mask; NHF2 set at 2L/kg$ min^{−1} $PBW; NHF3 set at 3L/kg$ min^{−1} $PBW; and h-CPAP with PEEP 7 $ cmH_{2} $O. PTPes $ min^{−1} $, pressure rate product (PRP), respiratory and other physiological parameters were collected towards the end of each step. Results Ten hypoxemic children with AVB were enrolled. PTPes*$ min^{−1} $, respiratory rate (RR), PRP, and heart rate (HR) decreased progressively from h-CPAP to NHF3, NHF2, and SOT (p < 0.01). Transcutaneous carbon dioxide tension ($ tcCO_{2} $) was lower during h-CPAP, NHF3, and NHF2 than during SOT (p < 0.001). $ SpO_{2} $:$ FiO_{2} $ was higher during h-CPAP than with all other support (p < 0.01). Conclusions In pediatric patients with AVB, h-CPAP was associated with lower WOB, better oxygenation, and lower $ tcCO_{2} $ than with SOT and NHF trials. Trial registration Clinicaltrials.gov NCT03689686 Registered 1 August 2018. © The Author(s) 2023
abstract_unstemmed	Objectives Acute viral bronchiolitis (AVB) is a major cause of hospitalization for children in developed and developing countries. Nasal high flow (NHF) therapy improves oxygenation and reduces respiratory drive by enhancing carbon dioxide wash-out. However, little is known about the physiological effects of non-invasive helmet continuous positive airway pressure (h-CPAP) and NHF on respiratory work of breathing (WOB) in pediatric patients with AVB. The present study measured esophageal pressure time product over 1 min (PTPes$ min^{−1} $), as a close surrogate for WOB during standard oxygen therapy (SOT), NHF delivered at incremental flow rates, and h-CPAP in hospitalized patients with AVB. Methods This is a physiological randomized crossover study with four 20-min steps: SOT delivered by a Venturi mask; NHF2 set at 2L/kg$ min^{−1} $PBW; NHF3 set at 3L/kg$ min^{−1} $PBW; and h-CPAP with PEEP 7 $ cmH_{2} $O. PTPes $ min^{−1} $, pressure rate product (PRP), respiratory and other physiological parameters were collected towards the end of each step. Results Ten hypoxemic children with AVB were enrolled. PTPes*$ min^{−1} $, respiratory rate (RR), PRP, and heart rate (HR) decreased progressively from h-CPAP to NHF3, NHF2, and SOT (p < 0.01). Transcutaneous carbon dioxide tension ($ tcCO_{2} $) was lower during h-CPAP, NHF3, and NHF2 than during SOT (p < 0.001). $ SpO_{2} $:$ FiO_{2} $ was higher during h-CPAP than with all other support (p < 0.01). Conclusions In pediatric patients with AVB, h-CPAP was associated with lower WOB, better oxygenation, and lower $ tcCO_{2} $ than with SOT and NHF trials. Trial registration Clinicaltrials.gov NCT03689686 Registered 1 August 2018. © The Author(s) 2023
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author2Str	Mauri, Tommaso Conti, Giorgio Catenacci, Stefano Scalia Marchesi, Tiziana Dona, Giada Figini, Maria Adele Babini, Giovanni Calderini, Edoardo
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doi_str	10.1007/s44253-023-00013-2
up_date	2024-07-03T13:42:03.573Z
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Nasal high flow (NHF) therapy improves oxygenation and reduces respiratory drive by enhancing carbon dioxide wash-out. However, little is known about the physiological effects of non-invasive helmet continuous positive airway pressure (h-CPAP) and NHF on respiratory work of breathing (WOB) in pediatric patients with AVB. The present study measured esophageal pressure time product over 1 min (PTPes$ min^{−1} $), as a close surrogate for WOB during standard oxygen therapy (SOT), NHF delivered at incremental flow rates, and h-CPAP in hospitalized patients with AVB. Methods This is a physiological randomized crossover study with four 20-min steps: SOT delivered by a Venturi mask; NHF2 set at 2L/kg$ min^{−1} $PBW; NHF3 set at 3L/kg$ min^{−1} $PBW; and h-CPAP with PEEP 7 $ cmH_{2} $O. PTPes $ min^{−1} $, pressure rate product (PRP), respiratory and other physiological parameters were collected towards the end of each step. Results Ten hypoxemic children with AVB were enrolled. PTPes*$ min^{−1} $, respiratory rate (RR), PRP, and heart rate (HR) decreased progressively from h-CPAP to NHF3, NHF2, and SOT (p < 0.01). Transcutaneous carbon dioxide tension ($ tcCO_{2} $) was lower during h-CPAP, NHF3, and NHF2 than during SOT (p < 0.001). $ SpO_{2} $:$ FiO_{2} $ was higher during h-CPAP than with all other support (p < 0.01). Conclusions In pediatric patients with AVB, h-CPAP was associated with lower WOB, better oxygenation, and lower $ tcCO_{2} $ than with SOT and NHF trials. 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Physiological effects of standard oxygen therapy, high-flow nasal cannula, and helmet CPAP in acute bronchiolitis: a randomized cross-over study

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