Use of continuous positive airway pressure (CPAP) in acute viral bronchiolitis: A systematic review§


  • Statement of authorship: Patricia Fontela and Pramod Puligandla designed the study; Mathew Donlan and Patricia Fontela collected the data; Mathew Donlan and Patricia Fontela analyzed the data; Patricia Fontela, Mathew Donlan, and Pramod Puligandla interpret the data; Mathew Donlan, Patricia Fontela, and Pramod Puligandla wrote the paper; Patricia Fontela and Pramod Puligandla supervised the research.

  • Authors declare that they have no conflicts of interests.

  • §

    Ethical adherence statement: Authors have declared that this study was performed in accordance to the research ethical guidelines.

  • Prior publication: Authors state that they have not submitted a related or duplicate manuscript for publication elsewhere.



Continuous positive airway pressure (CPAP), used either alone or associated with heliox (CPAP-He), has become a popular therapeutic option for bronchiolitis. This systematic review assesses the impact of CPAP on endotracheal intubation, carbon dioxide pressure (PCO2) and respiratory distress in patients with bronchiolitis.


Systematic search including studies that used CPAP or CPAP-He in infants with bronchiolitis admitted to a PICU. Data analysis included descriptive statistics and the GRADE system.


Five CPAP (one crossover randomized controlled trial [RCT] and four before–after studies) and three CPAP-He (one quasi-RCT and two before–after) studies were included. CPAP was reported to reduce PCO2 (−6.9 to −11.7 mmHg, respectively, P < 0.015), respiratory rate (−12 to −16 breaths/min after 2 hr, P < 0.01) and the modified Wood clinical asthma score (mWCAS, −2.2 points after 1 hr, P < 0.01). CPAP-He studies observed decreases in PCO2 (−9.7 mmHg, P < 0.05), mWCAS (−2.12 points, P < 0.001), and respiratory rate (−8 to −13.7 breaths/min, P < 0.05) after 1 hr of treatment. Endotracheal intubation rates ranged from 0–12.5% (CPAP-He) to 17–27% (CPAP). After applying the GRADE system, the quality of evidence for a beneficial effect of CPAP and CPAP-He was classified as low.


The evidence supporting the use of CPAP to reduce PCO2 and respiratory distress in bronchiolitis is of low methodological quality, and there is no conclusive evidence that CPAP reduces the need for intubation. No definitive conclusions could be drawn about the CPAP-He effect. Further research using higher quality methodology is needed to clarify the beneficial role of these interventions. Pediatr. Pulmonol. 2011; 46:736–746. © 2011 Wiley-Liss, Inc.