Nasal Continuous Positive Airway Pressure with Heliox in Infants with Acute Bronchiolitis

This is the first study aiming to assess the effects of heliox in combination with nasal continuous positive airway pressure (Hx-nCPAP) as a rescue treatment in infants with refractory acute bronchiolitis. Fifteen out of 78 infants with acute bronchiolitis consecutively admitted to PICU fulfilled the inclusion criteria: clinical score>or=5 or arterial oxygen saturation (SatO2)<or=92% or PCO2>50 mmHg, despite supportive therapy, nebulized L-epinephrine, and heliox therapy through non-rebreathing reservoir facemask. Hx-nCPAP was added as a rescue treatment. Baseline mean (standard deviation) values were: clinical score of 7.4 (1.2) points; PCO2 of 63.8 (12) mmHg; respiratory rate (RR) of 66.4 (9.9); and SatO2 of 88.6 (4.7)%. Clinical score, PCO2, RR and SatO2 improved during the study time (P<0.05). After 1 h the mean clinical score decreased by 1.5 points, with a total average decrease of 3.5 points at the end of the study period. The mean PCO2 diminished by 9 and 25 mmHg, after 1 and 48 h, respectively. The mean RR decreased 13 rpm after 1 h and 30 rpm after 48 h. The Hx-nCPAP total duration ranged from 2 to 14 days. Only one patient required endotracheal intubation. No adverse effects were detected. All patients recovered fully. In conclusion, Hx-nCPAP improved the clinical score, decreased the tachypnea and enhanced the CO2 elimination of infants with refractory acute bronchiolitis within 1h of administration, in a safe and non-invasive manner. Hx-nCPAP might reduce the need for endotracheal intubation. Further studies are needed.