Non-invasive ventilation as primary ventilatory support for infants with severe bronchiolitis

Objective: To report our experience of non-invasive ventilation (NIV) as primary ventilatory support strategy in infants admitted for severe bronchiolitis. Design and setting: Retrospective study in a paediatric intensive care unit of an university hospital. Patients: Infants aged less than 12 months, admitted for bronchiolitis during 2003-2004 and 2004-2005 winter epidemics. Intervention: NIV was used as the primary ventilatory support during the second winter (NIV period), whereas invasive ventilation (IV) was the only support employed during the first winter (IV period). NIV consisted in either continuous positive airway pressure (CPAP from 5 to 10 cmH(2)O) or bilevel positive airway pressure (inspiratory pressure from 12 to 18 cmH(2)O) with a nasal mask. Results: During the IV period, 53 infants were included, compared to 27 during the NIV period. The two groups did not differ in age or in number of premature births. Children in NIV group had less apnoea on admission. The intubation rate was reduced during NIV period (p < 0.001). No children had ventilator-associated pneumonia (VAP) during NIV period compared to nine during IV period (p < 0.05). In the NIV group, 10 infants (37%) required supplemental oxygen for more than 8 days compared to 33 children (65%) in IV group (p < 0.05). The length of hospital stay and the duration of ventilation were similar. Conclusions: In this retrospective study, the use of NIV decreased the rate of ventilator associated pneumonia and reduced the duration of oxygen requirement without prolonging the hospital stay.