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Positive end-expiratory pressure during Helmet ventilation in critically ill bronchiolitis: a multicenter randomized clinical trial
  • +17
  • emanuele rossetti,
  • Zaccaria Ricci,
  • Daniele Bonacina,
  • Cristina Giugni,
  • Ezio Bonanomi,
  • Marina Franci,
  • Marta Ciofi degli Atti,
  • Manuela L’Erario,
  • Daniela Perrotta,
  • Corrado Cecchetti,
  • linda appierto,
  • Luigi Dei Giudici,
  • alessandro germani,
  • Francesco Polisca,
  • Francesca Tortora,
  • Ivano Farinelli,
  • Fabrizio Chiusolo,
  • Paolo Serio,
  • roberto bianchi,
  • sergio giuseppe picardo
emanuele rossetti
Ospedale Pediatrico Bambino Gesu Biblioteca Medica

Corresponding Author:emanuele.rossetti@opbg.net

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Zaccaria Ricci
Azienda Ospedaliero Universitaria Meyer
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Daniele Bonacina
Biblioteca Medica Azienda Socio Sanitarie Territoriale Papa Giovanni XXIII
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Cristina Giugni
Azienda Ospedaliero Universitaria Meyer
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Ezio Bonanomi
Biblioteca Medica Azienda Socio Sanitarie Territoriale Papa Giovanni XXIII
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Marina Franci
Ospedale Pediatrico Bambino Gesu Biblioteca Medica
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Marta Ciofi degli Atti
Ospedale Pediatrico Bambino Gesu
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Manuela L’Erario
Azienda Ospedaliero Universitaria Meyer
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Daniela Perrotta
Ospedale Pediatrico Bambino Gesu Biblioteca Medica
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Corrado Cecchetti
Ospedale Pediatrico Bambino Gesu Biblioteca Medica
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linda appierto
Ospedale Pediatrico Bambino Gesu Biblioteca Medica
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Luigi Dei Giudici
Ospedale Pediatrico Bambino Gesu Biblioteca Medica
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alessandro germani
Ospedale Pediatrico Bambino Gesu Biblioteca Medica
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Francesco Polisca
Ospedale Pediatrico Bambino Gesu Biblioteca Medica
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Francesca Tortora
Ospedale Pediatrico Bambino Gesu Biblioteca Medica
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Ivano Farinelli
Ospedale Pediatrico Bambino Gesu Biblioteca Medica
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Fabrizio Chiusolo
Ospedale Pediatrico Bambino Gesu Biblioteca Medica
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Paolo Serio
Azienda Ospedaliero Universitaria Meyer
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roberto bianchi
Ospedale Pediatrico Bambino Gesu Biblioteca Medica
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sergio giuseppe picardo
Ospedale Pediatrico Bambino Gesu Biblioteca Medica
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Abstract

Objectives: To evaluate the effects of two different levels of positive end-expiratory pressure (PEEP) during helmet continuous positive airway pressure (HCPAP) support on the intubation rate in infants with bronchiolitis admitted to pediatric intensive care units (PICUs). Design: Multicentric prospective, randomized, open clinical trial. Setting: Four tertiary PICUs in Italy. Participants: Infants admitted to PICUs due to severe bronchiolitis and requiring respiratory support. Interventions: The enrolled patients were randomly assigned one of two PEEP levels for HCPAP support: high (P10 group: 10 cmH 2O) or low (P5 group: 5 cmH 2O). Measurements and Main Results: In total, 64 patients were randomly assigned to the P10 group, and 60 to the P5 group. The intubation rate was 9/60 (15%) and 9/64 (14%) in P5 and P10 groups (OR 0.94, 95% CI 0.36-2.46, p=0.99). Of the patients in the P5 group, 47 (78%) were escalated to a PEEP level of 10 cmH 2O. PEEP level was not associated to intubation rate (OR 0.69, 95% CI 0.19 to 2.40, p=0.57), after adjustment for age, gestational age, high flow nasal cannula application, bronchiolitis severity score and pediatric index of mortality 3. No cases of pneumothorax were observed in this study. Conclusions: In this trial on infants with severe bronchiolitis, a PEEP level of 10 cm H 2O during HCPAP in comparison to an initial level of 5 cm H 2O did not show to prevent intubation. These results are not conclusive due to the premature stopping.