Continuous negative extrathoracic pressure or continuous positive airway pressure compared to conventional ventilation for acute hypoxaemic respiratory failure in children
Bibliographic record
Abstract
Background Acute hypoxaemic respiratory failure (AHRF) is an important cause of mortality and morbidity in children. Positive pressure ventilation is currently the standard care, however, it does have complications. Continuous negative extrathoracic pressure ventilation (CNEP) or continuous positive airway pressure (CPAP) ventilation delivered via non‐invasive approaches (Ni‐CPAP) have shown certain beneficial effects in animal and uncontrolled human studies. Objectives To assess the effectiveness of CNEP or Ni‐CPAP in children with AHRF from non‐cardiogenic causes. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 1) which contains the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (January 1966 to January week 3, 2011), EMBASE (1980 to January 2011) and CINAHL (1982 to December 2010). Selection criteria Randomised or quasi‐randomised clinical trials of CNEP or Ni‐CPAP versus standard therapy (including positive pressure ventilation) involving children (from one month old to less than 18 years at time of randomisation) who met the criteria for diagnosis of AHRF with at least one of the outcomes reported. Data collection and analysis Risks of bias of the included study was assessed using allocation concealment, blinding of intervention, completeness of follow‐up and blinding of outcome measurements. Data on relevant outcomes were abstracted and the effect size was estimated by calculating risk ratio (RR) with 95% confidence intervals (CI) and risk difference (RD). Main results We identified two eligible studies; one of CPAP and one of CNEP (published as an abstract). The CPAP study enrolled 37 children to oxygen mask and CPAP and reported improvement in respiratory rate and oxygen saturation in both arms after 30 minutes of application. The CNEP study was published as an abstract and included 33 infants with bronchiolitis. In the CNEP study there was a reduction in the fraction of inspired oxygen (FiO2) (< 30% within one hour of initiation of therapy) in four participants in the CNEP group compared to none in the control group (RR 10.7, 95% CI 0.6 to 183.9). One infant required CPAP and one infant required nasal CPAP in the control group while all infants in the CNEP group were managed without intubation (RR for both outcomes 0.40, 95% CI 0.02 to 9.06). No adverse events were reported in ether of the included trials. Authors' conclusions There are a lack of well‐designed, controlled experiments of non‐invasive modes of respiratory support in children with AHRF. Studies assessing outcomes of mortality and avoidance of intubation and its associated complications, hospital stay and patient comfort are needed.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.035 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.009 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".