The Effects and Safety of Continuous Positive Airway Pressure in Children with Bronchiolitis: A Systematic Review and Meta-Analysis

Objectives To evaluate the effects and safety of continuous positive airway pressure (CPAP) for initial respiratory management of bronchiolitis. Methods PubMed, EMBASE, Cochrane Library, CNKI, Wanfang data and CQ VIP were searched until 17 June 2020. Randomized controlled trials (RCTs) which investigated the effect of CPAP for bronchiolitis were included. Results Twenty-seven RCTs met the eligibility criteria. In the comparison of CPAP versus standard oxygen therapy, CPAP can reduce the length of stay (LOS) in hospital, respiratory rate (RR), PaCO2, heart rate, mechanical ventilation and increase PaO2, but the SpO(2) and PH were not improved. In the comparison of CPAP versus high-flow nasal cannula, CPAP can reduce treatment failure, but the PICU LOS, Incidence of intubation, RR, Modified Woods Clinical Asthma Score were not decreased. Treatment failure may be less in helmet comparing with the mask though there was no quantitative analysis. Conclusion CPAP for the initial respiratory management significantly benefit children with bronchiolitis, the delivery of CPAP by helmet may be a better choice. More high-quality research is needed to confirm the conclusion.