Randomised controlled trial of nasal continuous positive airways pressure (CPAP) in bronchiolitis.

Aims: To compare continuous positive airways pressure (CPAP) with standard treatment (ST) in the management of bronchiolitis.

Methods: Children <1 year of age with bronchiolitis and capillary PCO2 >6 kPa were recruited and randomised to CPAP or ST and then crossed over to the alternative treatment after 12 h. ST was intravenous fluids and supplemental oxygen by nasal prongs or face mask. The change in PCO2 was compared between the groups after 12 and 24 h. Secondary outcomes were change in capillary pH, respiratory rate, pulse rate and the need for invasive ventilatory support.

Results: 29 of 31 children completed the study. PCO2 after 12 h fell by 0.92 kPa in children treated with CPAP compared with a rise of 0.04 kPa in those on ST (p<0.015). If CPAP was used first, there was a significantly better reduction in PCO2 than if it was used second. There were no differences in secondary outcome measures. CPAP was well tolerated with no complications identified.

Conclusions: This study suggests that CPAP compared with ST improves ventilation in children with bronchiolitis and hypercapnoea.