• M L Cataño-Jaramillo, J C Jaramillo-Bustamante, and I D Florez.
• Hospital General Medellín, Medellín, Colombia. Electronic address: marialuciacj@gmail.com.
• Med Intensiva. 2020 Nov 6.

ObjectiveTo compare the safety and effectiveness of Continuous Positive Airway Pressure (CPAP) vs. High Flow Nasal Cannula (HFNC) to prevent therapeutic failure and the need of invasive ventilation in children with acute moderate-severe bronchiolitis.DesignA systematic review and meta-analysis.SettingMedline, Embase, Lilacs, Cochrane and gray literature (May 2020) was performed.ParticipantsRandomized clinical trials patients with moderate to severe bronchiolitis.Main VariablesTherapeutic failure, need for invasive ventilation, adverse events, length of PCCU and of hospital stay.InterventionThe quality of the studies was assessed with the Cochrane risk and bias tool. We conducted meta-analysis using fixed effect model and random effects model.ResultsThree RCTs were included. Showed less risk of therapeutic failure with CPAP compared with HFNC (RR=0.7; 95%CI 0.5-0.99) developed hours later in patients with CPAP (MD=3.16; 95%CI 1.55-4.77). We did not find differences in other outcomes, such as need of invasive ventilation (RR=0.60; 95%CI 0.25-1.43), apnea (RR=0.40; 95%CI 0.08-1.99), or number of days in the intensive care unit (MD=0.02; 95%CI -0.38 to 0.42), and length of hospitalization (MD=-1.00; 95%IC -2.66 to 0.66). Adverse events (skin lesions) were more common with CPAP (RR 2.47; 95%CI 1.17-5.22).ConclusionsIn moderate/severe bronchiolitis CPAP demonstrated a lower risk of therapeutic failure and a longer time to failure. But more adverse events like nasal injury. There were no differences in other variables.Copyright © 2020 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

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