Community Acquired Pneumonia, Bronchiolitis
Conditions
Keywords
High -Velocity Nasal Insufflation, Continuous positive Airway Pressure, Pediatric Acute Respiratory Distress, pediatric intensive care unit
Brief summary
Acute breathing problems are a common reason for children to be admitted to the pediatric intensive care unit, and many of these children need breathing support without a breathing tube. High-Velocity Nasal Insufflation (HVNI) and nasal Continuous Positive Airway Pressure (nCPAP) are commonly used to help children breathe, but there is limited information comparing how well they work and how comfortable they are for children. This study aims to compare the clinical outcomes and tolerability of HVNI and nCPAP in children aged 1 month to 5 years with acute respiratory distress admitted to the pediatric intensive care unit, using clinical assessment and lung ultrasound findings.
Detailed description
Acute respiratory distress represents a major cause of morbidity and mortality in infants and young children and accounts for a significant proportion of pediatric intensive care unit admissions. A considerable number of affected children fail conventional low-flow oxygen therapy and require escalation to non-invasive respiratory support. High Velocity Nasal Insufflation delivers heated and humidified oxygen at high flow rates through nasal cannulae and may improve oxygenation by washing out nasopharyngeal dead space, reducing inspiratory resistance, and providing a degree of positive end-expiratory pressure. Nasal Continuous Positive Airway Pressure delivers a continuous distending airway pressure with supplemental oxygen, improving lung recruitment, reducing atelectasis, and enhancing ventilation-perfusion matching. Both modalities are commonly used in pediatric intensive care practice; however, evidence comparing their clinical effectiveness, tolerability, and impact on lung aeration in young children remains inconclusive. Lung ultrasound has emerged as a reliable, non-invasive bedside tool for assessment of lung aeration and disease severity in critically ill children. This prospective interventional study will enroll 80 children aged 1 month to 5 years admitted to the pediatric intensive care unit with acute respiratory distress who have failed low-flow oxygen therapy. Patients will be randomized into two groups: one group receiving High Velocity Nasal Insufflation and the other receiving nasal Continuous Positive Airway Pressure. All patients will undergo daily clinical assessment and lung ultrasound scoring during their pediatric intensive care unit (PICU) stay. Tolerability will be evaluated using the FLACC (Face, Legs, Activity, Cry, Consolability) pain scale. The primary outcome is improvement in lung aeration as assessed by lung ultrasound score. Secondary outcomes include assessment of clinical response to therapy based on respiratory rate, oxygen saturation (SpO₂), and need for escalation of respiratory support . The results of this study aim to provide evidence to guide selection of optimal non-invasive respiratory support in children with acute respiratory distress.
Interventions
High Velocity Nasal Insufflation will be delivered using a heated, humidified nasal cannula system to children aged 1 month to 5 years with acute respiratory distress who failed low-flow oxygen therapy. Therapy will be initiated and adjusted according to clinical condition and institutional PICU protocol. Patients will be monitored clinically and by daily lung ultrasound score during PICU stay.
DEVICENasal Continuous Positive Airway Pressure (Nasal CPAP)
Nasal Continuous Positive Airway Pressure will be delivered via nasal interface providing continuous positive airway pressure with supplemental oxygen to children aged 1 month to 5 years with acute respiratory distress who failed low-flow oxygen therapy. Settings will be adjusted according to clinical response and institutional PICU protocol. Patients will be monitored clinically and by daily lung ultrasound score during PICU stay.
Sponsors
Ain Shams University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Investigator)
Eligibility
Sex/Gender
ALL
Age
1 Months to 5 Years
Healthy volunteers
No
Inclusion criteria
* Children aged 1 month to 5 years * Admitted to the Pediatric Intensive Care Unit (PICU) * Diagnosed with acute respiratory distress * Failure of low-flow nasal oxygen therapy * Requiring non-invasive respiratory support * Informed consent obtained from parent or legal guardian
Exclusion criteria
* Presence of congenital or acquired cardiac disease * Neuromuscular disorders * Chronic lung disease * History of recurrent wheezing * History of cardio-respiratory arrest * Presence of significant comorbid chronic illness * Contraindication to non-invasive ventilation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Improvement in lung aeration assessed by lung ultrasound score | At Baseline, pre procedural , 48 hours . | To compare the effectiveness of High Velocity Nasal Insufflation versus Nasal Continuous Positive Airway Pressure in improving lung aeration in children with acute respiratory distress, assessed by daily lung ultrasound score during PICU stay. The LUS ranges from 0 to 36, where higher scores indicate worse lung aeration and lower scores indicate improvement. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Clinical improvement of respiratory distress assessed by Modified Respiratory Distress Score | Baseline and 48 hours after initiation of respiratory support | Clinical improvement assessed using a Modified Respiratory Distress Score(MRDS), which incorporates respiratory rate (breaths/min), oxygen saturation measured by pulse oximetry (SpO₂, %), and fraction of inspired oxygen (FiO₂, %). The MRDS ranges from 0 to 12, where higher scores indicate more severe respiratory distress and lower scores indicate clinical improvement. |
Countries
Egypt
Contacts
PRINCIPAL_INVESTIGATORTarek A. Abdelgawad, MD
Ain Shams University
Outcome results
None listed