Can CPAP prevent the progression of pediatric acute respiratory distress syndrome? A decade of experience in a Reference Center

Abstract

Viral infections are the main cause of acute respiratory failure in infants, which can progress to acute respiratory distress syndrome (ARDS), with high morbidity and mortality, so it is essential to implement strategies that prevent this progression. Recently, it has been proposed that increased work of breathing would not only be a warning symptom during the evolution of acute respiratory failure, but also a mechanism for the progression of injury, both lungs and diaphragm, coining the concept of patient self-inflicted lung injury. Since the first reports of ARDS, the usefulness of the use of continuous positive airway pressure (CPAP) has been raised, a non-invasive respiratory support therapy with wide access and low cost, capable of improving oxygenation and work of breathing. In this review, we summarize the current concepts of physiological bases, preclinical and clinical studies that support the theoretical capacity of CPAP to prevent ARDS progression, and the clinical experience of early implementation of bubble CPAP in the Pediatric Ward of the Hospital Dr. Franco Ravera Zunino, allowing a marked reduction in pediatric ICU admissions and the use of invasive mechanical ventilation.