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Q: CPAP for Bronchiolitis?

12 Sep, 08 | by Bob Phillips

Bronchiolitis baby

It’s simple really – Autumn is approaching and most paediatricians are gathering their Virally Protective Hankies to ward off the germs they know they’ll be assaulted by. There’s heavy training in many departments for the new docs — “if it’s bronchiolitis clinically, don’t X-ray them, don’t bleed them, don’t IV them and don’t give them a ‘trial’ of bronchodilators: accept it – there’s nothing you can do and the nurses will get them better with feeds, oxygen and cups of tea”.

But what about the really poorly one, that makes you think “I wish I was next door to PICU” .. surely you’re wanting just to wander down to SCBU and borrow that spare CPAP machine .. that has to work .. doesn’t it ..?

Well, a team from the North East have (probably) asked that question enough times, or been frightened by a SCBU Matron to such a degree, that they actually want to know the evidence.

What do you think?

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  • Ian Wacogne

    Bob,

    Surely all those intensivists can’t be wrong, can they?
    Of course, it depends on what sort of CPAP you’re talking about – nasal or short tube? And then comes the real problem – or the real subtlety – which is the old “Well, when I do it, of course, I’m successful because of factor X, Y and Z” – which might be do to with the pressure you use, or other adjuvant therapy (caffeine anyone? – my personal bias is that caffeine is started in order to give you something to do in three days time, ie stop it…) You might just summarise or dichotomise this most easily as CPAP as delivered by intensivists and non-intensivists.

    Anyway, I look forward to seeing the results of this.

    Ian

  • Bob Phillips

    Intensivists wrong, or undertake activity which just gives them something to do/measure, rather than improve things? You mean like pulmonary artery catheters? Or put the teaspoon in their bottle of not-quite-finished champagne?
    Physiological arguments are frequently right, but also conveniently forgotten when The Truth comes out (like putting babies to sleep on their fronts — who would have thought that would work physiologically? — or cardiac arrythmia suppression post-MI). And perhaps there is some variation in delivery methods of CPAP – but “skilled delivery” (or the like) is not a greatly important variable when the trials of HFOV and CV in neonates have been meta-regressed.
    So I reckon it’s a great question – which I really don’t know the answer to.

  • Heather Duncan

    Of course there is no evidence that CPAP for bronchiolitis works to improve clinically important outcomes – and no adequate evidence that it doesn’t. It does work, like all the other treatments, to stop the Dr from worrying about the patient. Actually, the Intensivists would much rather the General Paediatricians set up CPAP for bronchiolitis outside PICU so that we could pursue all those other evidence-based treatments in PICU (!) and of course avoid having to put the teaspoon in the champagne bottle…

  • Ian Wacogne

    But my point was whether or not you can generalise “CPAP works in group X” to “General paediatricians should deliver CPAP outside of the context of the PICU” Let’s be honest, most trials of this sort of thing happen in PICU world and there must be a million and one things that get done in PICU that I can’t do on a general ward – even a very good one. There seems to be a real risk if you make this leap; I think that I’d be delivering CPAP as a talented amateur. I’d be willing to learn, but could I reproduce the level of excellence we’re used to from PICU? I doubt it.

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