title: Continuous positive airway pressure with helmet versus mask in infants with bronchiolitis: an RCT.
abstract: BACKGROUND
  Noninvasive continuous positive airway pressure (CPAP) is usually applied with a nasal or facial mask to treat mild acute respiratory failure (ARF) in infants. A pediatric helmet has now been introduced in clinical practice to deliver CPAP. This study compared treatment failure rates during CPAP delivered by helmet or facial mask in infants with respiratory syncytial virus-induced ARF.
  
  
  METHODS
  In this multicenter randomized controlled trial, 30 infants with respiratory syncytial virus-induced ARF were randomized to receive CPAP by helmet (n = 17) or facial mask (n = 13). The primary endpoint was treatment failure rate (defined as due to intolerance or need for intubation). Secondary outcomes were CPAP application time, number of patients requiring sedation, and complications with each interface.
  
  
  RESULTS
  Compared with the facial mask, CPAP by helmet had a lower treatment failure rate due to intolerance (3/17 [17%] vs 7/13 [54%], P = .009), and fewer infants required sedation (6/17 [35%] vs 13/13 [100%], P = .023); the intubation rates were similar. In successfully treated patients, CPAP resulted in better gas exchange and breathing pattern with both interfaces. No major complications due to the interfaces occurred, but CPAP by mask had higher rates of cutaneous sores and leaks.
  
  
  CONCLUSIONS
  These findings confirm that CPAP delivered by helmet is better tolerated than CPAP delivered by facial mask and requires less sedation. In addition, it is safe to use and free from adverse events, even in a prolonged clinical setting.
authors.affiliation: Pediatric ICU, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; giovannachid@libero.it.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Chidini
authors.affiliation: Pediatric ICU, Department of Anaesthesiology and Intensive Care, University Hospital "A. Gemelli," Catholic University of the Sacred Heart, Rome, Italy;
authors.forename: Marco
authors.initials: M
authors.lastname: Piastra
authors.affiliation: University of Milan, Milan, Italy;
authors.forename: Tiziana
authors.initials: T
authors.lastname: Marchesi
authors.affiliation: Pediatric ICU, Department of Anaesthesiology and Intensive Care, University Hospital "A. Gemelli," Catholic University of the Sacred Heart, Rome, Italy;
authors.forename: Daniele
authors.initials: D
authors.lastname: De Luca
authors.affiliation: Pediatric ICU, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy;
authors.forename: Luisa
authors.initials: L
authors.lastname: Napolitano
authors.affiliation: Department of Anesthesia and Intensive Care, Children's Hospital Vittore Buzzi, Istituti Clinici di Perfezionamento, Milan, Italy; and.
authors.forename: Ida
authors.initials: I
authors.lastname: Salvo
authors.affiliation: Department of Anesthesia and Intensive Care, Children's Hospital Vittore Buzzi, Istituti Clinici di Perfezionamento, Milan, Italy; and.
authors.forename: Andrea
authors.initials: A
authors.lastname: Wolfler
authors.affiliation: Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, IRCCS AOU San Martino - IST, Genoa, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Pelosi
authors.affiliation: University of Milan, Milan, Italy;
authors.forename: Mirco
authors.initials: M
authors.lastname: Damasco
authors.affiliation: Pediatric ICU, Department of Anaesthesiology and Intensive Care, University Hospital "A. Gemelli," Catholic University of the Sacred Heart, Rome, Italy;
authors.forename: Giorgio
authors.initials: G
authors.lastname: Conti
authors.affiliation: Pediatric ICU, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy;
authors.forename: Edoardo
authors.initials: E
authors.lastname: Calderini
mesh_terms: D001990:Bronchiolitis, Viral / Q000175:diagnosis / Q000628:therapy*; D045422:Continuous Positive Airway Pressure / Q000295:instrumentation*; D005260:Female; D006260:Head Protective Devices; D006801:Humans; D007223:Infant; D007558:Italy; D008297:Male; D008397:Masks; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000628:therapy*; D018357:Respiratory Syncytial Virus Infections / Q000175:diagnosis / Q000628:therapy*; D017211:Treatment Failure
keywords: acute respiratory failure; children; continuous positive airway pressure; helmet