Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris, France.
Université de Paris, EA, 7330 VIFASOM, Paris, France.
Pediatr Pulmonol. 2023 Jul;58(7):2000-2008. doi: 10.1002/ppul.26424. Epub 2023 Apr 25.
To assess if noninvasive positive pressure ventilation (NIPPV) is associated with a greater reduction in respiratory effort as compared to continuous positive airway pressure (CPAP) during severe acute bronchiolitis, with both supports set either clinically or physiologically.
Twenty infants (median [IQR] age 1.2 [0.9; 3.2] months) treated <24 h with noninvasive respiratory support (CPAP Clin, set at 7 cmH O, or NIPPV Clin) for bronchiolitis were included in a prospective single-center crossover study. Esogastric pressures were measured first with the baseline support, then with the other support. For each support, recordings were performed with the clinical setting and a physiological setting (CPAP Phys and NIPPV Phys), aiming at normalising respiratory effort. Patients were then treated with the optimal support. The primary outcome was the greatest reduction in esophageal pressure-time product (PTP /min). Other outcomes included improvement of the other components of the respiratory effort.
NIPPV Clin and Phys were associated with a lower PTP /min (164 [105; 202] and 106 [78; 161] cmH O s/min, respectively) than CPAP Clin (178 [145; 236] cmH O s/min; p = 0.01 and 2 × 10 , respectively). NIPPV Clin and Phys were also associated with a significant reduction of all other markers of respiratory effort as compared to CPAP Clin. PTP /min with NIPPV (Clin or Phys) was not different from PTP /min with CPAP Phys. There was no significant difference between physiological and clinical settings.
NIPPV is associated with a significant reduction in respiratory effort as compared to CPAP set at +7 cmH O in infants with severe acute bronchiolitis. CPAP Phys performs as well as NIPPV Clin.
评估在严重急性细支气管炎中，与连续气道正压通气（CPAP）相比，无论是临床设定还是生理设定，无创正压通气（NIPPV）是否能更有效地降低呼吸功。
本前瞻性单中心交叉研究纳入了 20 名在发病 24 小时内接受无创呼吸支持（CPAP Clin，设定为 7cmH2O，或 NIPPV Clin）治疗的细支气管炎婴儿。首先用基础支持测量食管内压力，然后用另一种支持。对于每种支持，在临床设置和生理设置（CPAP Phys 和 NIPPV Phys）下进行记录，以实现呼吸功的正常化。然后，患者接受最佳支持治疗。主要结局为食管压力-时间乘积（PTP/min）的最大降低量。其他结局包括呼吸功的其他成分的改善。
NIPPV Clin 和 Phys 与较低的 PTP/min（分别为 164[105;202]和 106[78;161]cmH2O·s/min）相关，而 CPAP Clin 为 178[145;236]cmH2O·s/min（p=0.01 和 2×10-4，分别）。与 CPAP Clin 相比，NIPPV Clin 和 Phys 还与所有其他呼吸功标志物的显著降低相关。NIPPV（Clin 或 Phys）的 PTP/min 与 CPAP Phys 的 PTP/min 无差异。生理和临床设置之间无显著差异。
在严重急性细支气管炎婴儿中，与 CPAP 设定为+7cmH2O 相比，NIPPV 与呼吸功的显著降低相关。CPAP Phys 的表现与 NIPPV Clin 相当。
