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Tirelli F, Todeschini Premuda M, Francaviglia G, Frigo AC, Baraldi E, Da Dalt L, Bressan S. A two-tiered high-flow nasal cannula approach does not increase intensive care utilization and hospital length of stay in bronchiolitis. Eur J Pediatr 2024:10.1007/s00431-024-05656-7. [PMID: 38926186 DOI: 10.1007/s00431-024-05656-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/12/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024]
Abstract
While concerns about high-flow nasal cannula oxygen (HFNC) overuse and associated increased use of hospital resources are rapidly spreading, a two-tiered approach in its use is recommended by recent bronchiolitis guidelines. However, data on its effects in practice have not been reported. We aimed to analyze the trends in use of HFNC, hospitalizations, length of stay (LOS), and intensive care unit (ICU) admissions for bronchiolitis in a tertiary care center using a two-tiered HFNC approach since its introduction in practice. We retrospectively included data of children < 12 months of age who presented to the Paediatric Emergency Department (PED) and were hospitalized for bronchiolitis at our institution in the epidemic season between October 1st and April 30th during the years 2012-2023 and compared the clinical data across the years. Of the 687 hospitalized children included, 79.9% required oxygen supplementation. Use of HFNC significantly increased since its implementation (from 25% in 2012-2013 to over 60% since 2019-2020, p < 0.0001) and was most frequently administered as rescue treatment (in 57.5% of patients). There was no increased trend in ICU admissions (between 1.5% and 10.0% of hospitalizations across seasons, p = 0.40), while LOS, after increasing between 2013 and 2016 (medians between 4.0 and 5.4 days), remained stable thereafter (medians between 3.8 and 4.3 days). CONCLUSIONS The use of HFNC according to a two-tiered approach does not appear to be associated with an increase in ICU utilization or LOS. WHAT IS KNOWN • Bronchiolitis is one of the most common reasons for hospitalization in infants. • Use high-flow nasal canulae oxygen (HFNC) has rapidly spread outside the intensive care unit (ICU) to treat infants with bronchiolitis, although increasing evidence has dampened the initial enthusiasm about their effectiveness. • Concerns nowadays are rising about HFNC overuse and associated increased use of hospital resources, including escalation of care to ICU. WHAT IS NEW • A more selective use of HFNC according to a "two-tiered approach", intended as a second-line rescue treatment in non-severely ill children who fail standard oxygen therapy, is not associated with increased ICU and length of hospital stay.
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Affiliation(s)
- Francesca Tirelli
- Department of Women's and Children's Health, University of Padova, Via Giustiniani 3, 35128, Padua, Italy
| | - Marco Todeschini Premuda
- Department of Women's and Children's Health, University of Padova, Via Giustiniani 3, 35128, Padua, Italy
| | - Giulia Francaviglia
- Department of Women's and Children's Health, University of Padova, Via Giustiniani 3, 35128, Padua, Italy
| | - Anna Chiara Frigo
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Vascular, Thoracic Sciences, and Public Health, University of Padova, Via Loredan 18, Padua, Italy
| | - Eugenio Baraldi
- Department of Women's and Children's Health, University of Padova, Via Giustiniani 3, 35128, Padua, Italy
| | - Liviana Da Dalt
- Department of Women's and Children's Health, University of Padova, Via Giustiniani 3, 35128, Padua, Italy
| | - Silvia Bressan
- Department of Women's and Children's Health, University of Padova, Via Giustiniani 3, 35128, Padua, Italy.
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Dunbar KS, Fox SN, Thomas JF, Brittan MS, Soskolne G, Cotter JM. When to Transfer: Predictors of Pediatric High Flow Nasal Cannula Failure at a Community Hospital. Hosp Pediatr 2024; 14:45-51. [PMID: 38093648 DOI: 10.1542/hpeds.2023-007298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2024]
Abstract
OBJECTIVES To identify risk factors of high flow nasal cannula (HFNC) failure at a US pediatric hospital without a co-located ICU. METHODS Retrospective cohort study of patients aged 0 to 18 years who were started on HFNC in the emergency department or inpatient unit at a community hospital over a 16-month period. Children with chronic medical conditions were excluded. Outcome was HFNC failure, defined as HFNC need greater than floor limit, noninvasive positive pressure, or mechanical ventilation. In bivariate analysis, we compared demographic and clinical factors between those with and without failure. We included variables in a multivariable model on the basis of statistical significance. We used Poisson regression with robust error variance to calculate the adjusted relative risk (aRR) of failure for each variable. RESULTS Of 195 children, 51% had HFNC failure. In adjusted analysis, failure was higher in all age groups <12 months as compared with older children. For example, children aged 3 to 5 months had a higher risk of failure compared with patients 12 months or older (aRR 1.85, confidence interval [CI] 1.34-2.54). Patients with an asthma exacerbation had a higher risk of failure (aRR 1.39, CI 1.03-1.88). Patients whose respiratory rate or heart rate did not improve also had a higher risk of failure (aRR 1.73, CI 1.24-2.41; aRR 1.47, CI 1.14-1.90). CONCLUSIONS Patients who were younger, had asthma, and did not have improved respiratory rate or heart rate after HFNC were more likely to experience HFNC failure.
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Affiliation(s)
- Kimiko S Dunbar
- Section of Pediatric Hospital Medicine, Children's Hospital Colorado, University of Colorado Denver, Aurora Colorado
- University of Colorado School of Medicine, Aurora, Colorado
| | - Sarah N Fox
- University of Colorado School of Medicine, Aurora, Colorado
| | - Jacob F Thomas
- Adult and Child Consortium for Health Outcomes Research and Delivery Science
- University of Colorado School of Medicine, Aurora, Colorado
| | - Mark S Brittan
- Section of Pediatric Hospital Medicine, Children's Hospital Colorado, University of Colorado Denver, Aurora Colorado
- Adult and Child Consortium for Health Outcomes Research and Delivery Science
- University of Colorado School of Medicine, Aurora, Colorado
| | - Gayle Soskolne
- Section of Pediatric Hospital Medicine, Children's Hospital Colorado, University of Colorado Denver, Aurora Colorado
- University of Colorado School of Medicine, Aurora, Colorado
| | - Jillian M Cotter
- Section of Pediatric Hospital Medicine, Children's Hospital Colorado, University of Colorado Denver, Aurora Colorado
- University of Colorado School of Medicine, Aurora, Colorado
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Al-Mukhaini KS, Shaikh S, Al-Kharusi AK, Thani SS, Al-Abdwani RM, Al-Senaidi OA, Elkhamisy AE, Birru FD, Al-Fahdi AA. Outcome of Noninvasive Respiratory Support in Pediatric High-Dependency Units for Acute Respiratory Distress. Respir Care 2023; 68:1237-1244. [PMID: 36973036 PMCID: PMC10468171 DOI: 10.4187/respcare.10603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/27/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Noninvasive respiratory support (NRS) is widely used in pediatric ICUs (PICUs). However, there is limited experience regarding the utilization of NRS in non-PICU settings. We aimed to evaluate the success rate of NRS in pediatric high-dependency units (PHDUs), identify predictors of NRS failure, quantify adverse events, and assess outcomes. METHODS We included infants and children (> 7 d to < 13 y old) admitted to PHDU in 2 tertiary hospitals for acute respiratory distress over a 19-month period. Collected data included diagnosis, type and duration of NRS, adverse events, and the need for PICU transfer or invasive ventilation. RESULTS Two hundred and ninety-nine children were included, with a median age of 7 (interquartile range [IQR] 3-25) months and a median weight of 6.1 (IQR 4.3-10.5) kg. Bronchiolitis (37.5%), pneumonia (34.1%), and asthma (12.7%) were the most frequent diagnoses. Median NRS duration was 2 (IQR 1-3) d. At baseline, median SpO2 was 96% (IQR 90-99); median pH was 7.36 (IQR 7.31-7.41), and median PCO2 was 44 (IQR 36-53) mm Hg. Overall, 234 (78.3%) children were successfully managed in PHDU, whereas 65 (21.7%) required transfer to PICU. Thirty-eight (12.7%) needed invasive ventilation on a median time of 43.5 (IQR 13.5-108.0) h. On multivariable analysis, maximum FIO2 > 0.5 (odds ratio 4.49 [95% CI 1.36-14.9], P = .01) and PEEP > 7 cm H2O (odds ratio 3.37 [95% CI 1.49-7.61], P = .004) were predictors for NRS failure. Significant apnea, cardiopulmonary resuscitation, and air leak syndrome were reported in 0.3, 0.7, and 0.7% children, respectively. CONCLUSIONS In our cohort, we found NRS in PHDU safe and effective; however, maximum FIO2 > 0.5 post treatment and PEEP > 7 cm H2O were associated with NRS failure.
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Affiliation(s)
- Khaloud S Al-Mukhaini
- Pediatric Intensive Care Section, Department of Child Health, Royal Hospital, Muscat, Oman.
| | - Samiuddin Shaikh
- Pediatric Intensive Care Section, Department of Child Health, Royal Hospital, Muscat, Oman
| | | | - Saif Sa Thani
- Pediatric Intensive Care Section, Department of Child Health, Royal Hospital, Muscat, Oman
| | | | - Omar A Al-Senaidi
- Pediatrics Residency Training Program, Oman Medical Specialty Board, Muscat, Oman
| | - Ahmed E Elkhamisy
- Pediatric Intensive Care Section, Department of Child Health, Royal Hospital, Muscat, Oman
| | - Florence D Birru
- Division of Respiratory Medicine, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Amna A Al-Fahdi
- Pediatrics Residency Training Program, Oman Medical Specialty Board, Muscat, Oman
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Abbate F, Depietri G, Tinelli C, Massimetti G, Picariello S, Peroni D, Di Cicco M. Impact of the publication of the Italian guidelines for bronchiolitis on the management of hospitalized children in Pisa, Italy. Pediatr Pulmonol 2023. [PMID: 37154513 DOI: 10.1002/ppul.26460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 04/19/2023] [Accepted: 04/27/2023] [Indexed: 05/10/2023]
Abstract
Bronchiolitis represents one of the major causes of hospitalization and mortality in children younger than 1 year, but its management continues to be heterogenous both in those who are hospitalized and in those who are not. To assess the impact of the publication of the Italian guidelines on bronchiolitis in October 2014, we analyzed data from children aged ≤12 months admitted for bronchiolitis at the University Hospital of Pisa from January 2010 to December 2019, dividing them into two groups based on whether admission was either preceding (Group 1) or following (Group 2) the publication of the guidelines. 346 patients (mean age 4.1 ± 2.8 months, 55% males) were admitted in the study period; 43.3%, 49.4%, and 7.3% of patients had mild, moderate or severe bronchiolitis, respectively. The mean length of hospital stay was 6.7 ± 2.9 days; 90.5% of the patients underwent nasal swab and 200 patients tested positive for RSV (in mono or coinfection with other viruses). We found no difference in RSV prevalence and severity distribution between the two groups, while we observed a significant reduction in the use of both chest X-rays (66.9% vs. 34.8%, p < 0.001), blood testing (93.4% vs. 58.2%, p < 0.001) and inhaled or systemic corticosteroids (93.1% vs. 47.8%, p < 0.001) in Group 2. No significant reduction in the use of antibiotics and of inhaled β2 agonists was found. Our data suggest that the publication of the Italian guidelines for bronchiolitis has contributed to improving the management of patients admitted for bronchiolitis in our Unit.
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Affiliation(s)
- Federica Abbate
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Pediatrics Unit, Pisa University Hospital, Pisa, Italy
| | - Greta Depietri
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Pediatrics Unit, Pisa University Hospital, Pisa, Italy
| | - Camilla Tinelli
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Gabriele Massimetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sara Picariello
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Pediatrics Unit, Pisa University Hospital, Pisa, Italy
| | - Diego Peroni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Pediatrics Unit, Pisa University Hospital, Pisa, Italy
| | - Maria Di Cicco
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Pediatrics Unit, Pisa University Hospital, Pisa, Italy
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Hodgson KA, Wilkinson D, De Paoli AG, Manley BJ. Nasal high flow therapy for primary respiratory support in preterm infants. Cochrane Database Syst Rev 2023; 5:CD006405. [PMID: 37144837 PMCID: PMC10161968 DOI: 10.1002/14651858.cd006405.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Nasal high flow (nHF) therapy provides heated, humidified air and oxygen via two small nasal prongs, at gas flows of more than 1 litre/minute (L/min), typically 2 L/min to 8 L/min. nHF is commonly used for non-invasive respiratory support in preterm neonates. It may be used in this population for primary respiratory support (avoiding, or prior to the use of mechanical ventilation via an endotracheal tube) for prophylaxis or treatment of respiratory distress syndrome (RDS). This is an update of a review first published in 2011 and updated in 2016. OBJECTIVES To evaluate the benefits and harms of nHF for primary respiratory support in preterm infants compared to other forms of non-invasive respiratory support. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date March 2022. SELECTION CRITERIA We included randomised or quasi-randomised trials comparing nHF with other forms of non-invasive respiratory support for preterm infants born less than 37 weeks' gestation with respiratory distress soon after birth. DATA COLLECTION AND ANALYSIS We used standard Cochrane Neonatal methods. Our primary outcomes were 1. death (before hospital discharge) or bronchopulmonary dysplasia (BPD), 2. death (before hospital discharge), 3. BPD, 4. treatment failure within 72 hours of trial entry and 5. mechanical ventilation via an endotracheal tube within 72 hours of trial entry. Our secondary outcomes were 6. respiratory support, 7. complications and 8. neurosensory outcomes. We used GRADE to assess the certainty of evidence. MAIN RESULTS We included 13 studies (2540 infants) in this updated review. There are nine studies awaiting classification and 13 ongoing studies. The included studies differed in the comparator treatment (continuous positive airway pressure (CPAP) or nasal intermittent positive pressure ventilation (NIPPV)), the devices for delivering nHF and the gas flows used. Some studies allowed the use of 'rescue' CPAP in the event of nHF treatment failure, prior to any mechanical ventilation, and some allowed surfactant administration via the INSURE (INtubation, SURfactant, Extubation) technique without this being deemed treatment failure. The studies included very few extremely preterm infants less than 28 weeks' gestation. Several studies had unclear or high risk of bias in one or more domains. Nasal high flow compared with continuous positive airway pressure for primary respiratory support in preterm infants Eleven studies compared nHF with CPAP for primary respiratory support in preterm infants. When compared with CPAP, nHF may result in little to no difference in the combined outcome of death or BPD (risk ratio (RR) 1.09, 95% confidence interval (CI) 0.74 to 1.60; risk difference (RD) 0, 95% CI -0.02 to 0.02; 7 studies, 1830 infants; low-certainty evidence). Compared with CPAP, nHF may result in little to no difference in the risk of death (RR 0.78, 95% CI 0.44 to 1.39; 9 studies, 2009 infants; low-certainty evidence), or BPD (RR 1.14, 95% CI 0.74 to 1.76; 8 studies, 1917 infants; low-certainty evidence). nHF likely results in an increase in treatment failure within 72 hours of trial entry (RR 1.70, 95% CI 1.41 to 2.06; RD 0.09, 95% CI 0.06 to 0.12; number needed to treat for an additional harmful outcome (NNTH) 11, 95% CI 8 to 17; 9 studies, 2042 infants; moderate-certainty evidence). However, nHF likely does not increase the rate of mechanical ventilation (RR 1.04, 95% CI 0.82 to 1.31; 9 studies, 2042 infants; moderate-certainty evidence). nHF likely results in a reduction in pneumothorax (RR 0.66, 95% CI 0.40 to 1.08; 10 studies, 2094 infants; moderate-certainty evidence) and nasal trauma (RR 0.49, 95% CI 0.36 to 0.68; RD -0.06, 95% CI -0.09 to -0.04; 7 studies, 1595 infants; moderate-certainty evidence). Nasal high flow compared with nasal intermittent positive pressure ventilation for primary respiratory support in preterm infants Four studies compared nHF with NIPPV for primary respiratory support in preterm infants. When compared with NIPPV, nHF may result in little to no difference in the combined outcome of death or BPD, but the evidence is very uncertain (RR 0.64, 95% CI 0.30 to 1.37; RD -0.05, 95% CI -0.14 to 0.04; 2 studies, 182 infants; very low-certainty evidence). nHF may result in little to no difference in the risk of death (RR 0.78, 95% CI 0.36 to 1.69; RD -0.02, 95% CI -0.10 to 0.05; 3 studies, 254 infants; low-certainty evidence). nHF likely results in little to no difference in the incidence of treatment failure within 72 hours of trial entry compared with NIPPV (RR 1.27, 95% CI 0.90 to 1.79; 4 studies, 343 infants; moderate-certainty evidence), or mechanical ventilation within 72 hours of trial entry (RR 0.91, 95% CI 0.62 to 1.33; 4 studies, 343 infants; moderate-certainty evidence). nHF likely results in a reduction in nasal trauma, compared with NIPPV (RR 0.21, 95% CI 0.09 to 0.47; RD -0.17, 95% CI -0.24 to -0.10; 3 studies, 272 infants; moderate-certainty evidence). nHF likely results in little to no difference in the rate of pneumothorax (RR 0.78, 95% CI 0.40 to 1.53; 4 studies, 344 infants; moderate-certainty evidence). Nasal high flow compared with ambient oxygen We found no studies examining this comparison. Nasal high flow compared with low flow nasal cannulae We found no studies examining this comparison. AUTHORS' CONCLUSIONS The use of nHF for primary respiratory support in preterm infants of 28 weeks' gestation or greater may result in little to no difference in death or BPD, compared with CPAP or NIPPV. nHF likely results in an increase in treatment failure within 72 hours of trial entry compared with CPAP; however, it likely does not increase the rate of mechanical ventilation. Compared with CPAP, nHF use likely results in less nasal trauma and likely a reduction in pneumothorax. As few extremely preterm infants less than 28 weeks' gestation were enrolled in the included trials, evidence is lacking for the use of nHF for primary respiratory support in this population.
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Affiliation(s)
- Kate A Hodgson
- Women's Newborn Research Centre, The Royal Women's Hospital, Parkville, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - Dominic Wilkinson
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | | | - Brett J Manley
- Women's Newborn Research Centre, The Royal Women's Hospital, Parkville, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
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Huang JX, Colwell B, Vadlaputi P, Sauers-Ford H, Smith BJ, McKnight H, Witkowski J, Padovani A, Aghamohammadi S, Tzimenatos L, Beck S, Reneau K, Nill B, Harbour D, Pegadiotes J, Natale J, Hamline M, Siefkes H. Protocol-Driven Initiation and Weaning of High-Flow Nasal Cannula for Patients With Bronchiolitis: A Quality Improvement Initiative. Pediatr Crit Care Med 2023; 24:112-122. [PMID: 36661418 PMCID: PMC9869459 DOI: 10.1097/pcc.0000000000003136] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Bronchiolitis is the most common cause for nonelective infant hospitalization in the United States with increasing utilization of high-flow nasal cannula (HFNC). We standardized initiation and weaning of HFNC for bronchiolitis and quantified the impact on outcomes. Our specific aim was to reduce hospital and ICU length of stay (LOS) by 10% between two bronchiolitis seasons after implementation. DESIGN A quality improvement (QI) project using statistical process control methodology. SETTING Tertiary-care children's hospital with 24 PICU and 48 acute care pediatric beds. PATIENTS Children less than 24 months old with bronchiolitis without other respiratory diagnoses or underlying cardiac, respiratory, or neuromuscular disorders between December 2017 and November 2018 (baseline), and December 2018 and February 2020 (postintervention). INTERVENTIONS Interventions included development of an HFNC protocol with initiation and weaning guidelines, modification of protocol and respiratory assessment classification, education, and QI rounds with a focus on efficient HFNC weaning, transfer, and/or discharge. MEASUREMENTS AND MAIN RESULTS A total of 223 children were included (96 baseline and 127 postintervention). The primary outcome metric, average LOS per patient, decreased from 4.0 to 2.8 days, and the average ICU LOS per patient decreased from 2.8 to 1.9 days. The secondary outcome metric, average HFNC treatment hours per patient, decreased from 44.0 to 36.3 hours. The primary and secondary outcomes met criteria for special cause variation. Balancing measures included ICU readmission rates, 30-day readmission rates, and adverse events, which were not different between the two periods. CONCLUSIONS A standardized protocol for HFNC management for patients with bronchiolitis was associated with decreased hospital and ICU LOS, less time on HFNC, and no difference in readmissions or adverse events.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Shelli Beck
- University of California Davis Children’s Hospital
| | | | - Barbara Nill
- University of California Davis Children’s Hospital
| | - Dawn Harbour
- University of California Davis Children’s Hospital
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Nascimento MS, do Prado C, Costa ELV, Alcala GC, Corrêa LC, Rossi FS, Amato MBP, Rebello CM. Effect of flow rate on the end-expiratory lung volume in infants with bronchiolitis using high-flow nasal cannula evaluated through electrical impedance tomography. Pediatr Pulmonol 2022; 57:2681-2687. [PMID: 35931651 DOI: 10.1002/ppul.26082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 06/13/2022] [Accepted: 07/19/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To evaluate the effects of four flow rates on the functional residual capacity (FRC) and pulmonary ventilation distribution while using a high-flow nasal cannula (HFNC). WORKING HYPOTHESIS Our hypothesis is that flow rates below 1.5 L·kg-1 ·min-1 lead to FRC loss and respiratory distress. STUDY DESIGN A single-center, prospective clinical study. PATIENT SELECTION Infants diagnosed with acute viral bronchiolitis were given HFNC. METHODOLOGY Through a prospective clinical study, the effects of four different flow rates, 2.0, 1.5, 1.0, and 0.5 L·kg-1 ·min-1 , on FRC and the pulmonary ventilation pattern were evaluated using electrical impedance tomography. The impedance variation (delta Z), end-expiratory lung volume (EELZ), respiratory rate, heart rate, respiratory distress score, and saturation/fraction of inspired oxygen ratio (SpO2 /FI O2 ), were also evaluated at each flow rate. RESULTS Among the 11 infants included, There was a decrease in respiratory distress score at a flow rate of 1.5 L·kg-1 ·min-1 (*p = 0.021), and at a flow rate of 2.0 L·kg-1 ·min-1 (**p = 0.003) compared to 0.5 L·kg-1 ·min-1 . There was also a small but significant increase in SpO2 /FiO2 at flow rates of 1.5 (*p = 0.023), and 2.0 L·kg-1 ·min-1 (**p = 0.008) compared to 0.5 L·kg-1 ·min-1 . There were no other significant changes in the clinical parameters. In the global EELZ measurements, there was a significant increase under a flow rate of 2.0 L·kg-1 ·min-1 as compared to 0.5 L·kg-1 ·min-1 (p = 0.03). In delta Z values, there were no significant variations between the different flow rates. CONCLUSION The ∆EELZ increases at the highest flow rates were accompanied by decreased distress scores and improved oxygenation.
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Affiliation(s)
- Milena S Nascimento
- Maternal-Child Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Cristiane do Prado
- Maternal-Child Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Glasiele C Alcala
- Divisão de Pneumologia, Departamento Cardiopulmonar, Instituto do Coração (INCOR), Sao Paulo City, Sao Paulo, Brazil
| | - Letícia C Corrêa
- Divisão de Pneumologia, Departamento Cardiopulmonar, Instituto do Coração (INCOR), Sao Paulo City, Sao Paulo, Brazil
| | - Felipe S Rossi
- Maternal-Child Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Marcelo B P Amato
- Divisão de Pneumologia, Departamento Cardiopulmonar, Instituto do Coração (INCOR), Sao Paulo City, Sao Paulo, Brazil
| | - Celso M Rebello
- Maternal-Child Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
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Mukherjee P, Bhattacharya D, Esquinas AM, Mandal M. HFNC can bring the children with bronchiolitis off the ventilator earlier: Fact or fiction? Respir Med 2022; 204:107033. [DOI: 10.1016/j.rmed.2022.107033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 10/26/2022] [Indexed: 11/09/2022]
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Sunkonkit K, Kungsuwan S, Seetaboot S, Reungrongrat S. Factors associated with failure of using high flow nasal cannula in children. THE CLINICAL RESPIRATORY JOURNAL 2022; 16:732-739. [PMID: 36038361 PMCID: PMC9629993 DOI: 10.1111/crj.13533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 08/05/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION High flow nasal cannula (HFNC) has significantly success in treating acute respiratory distress while HFNC failure dramatically increases mortality and morbidity. OBJECTIVE To describe factors associated with failure of HFNC use in children. METHODS We performed a retrospective observational study using demographic and laboratory findings. We compared clinical and laboratory variables in both successful and failed HFNC groups. The correlations between factors and HFNC failure were constructed by binary logistic regression analysis. RESULTS Between August 2016 and May 2018, 250 children receiving HFNC (median age 16 months; range 1-228 months, male 50.8%) were enrolled. Pneumonia was the most common cause of respiratory distress, and the median length of stay (LOS) in hospital was 11 days. HFNC failure was found 16.4% while HFNC complication was 4.8% including epistaxis, pressure sore, and gastric distension. Based on multivariable logistic regression analysis, factors associated with HFNC failure were children with congenital heart disease comorbidity (p = 0.005), HFNC use with maximum FiO2 > 0.6 (p = 0.021), lobar infiltration on chest X-ray (p = 0.012), the reduction of heart rate, and respiratory rate <20% after 1 h of HFNC use (p = 0.001 and p = 0.001, respectively). CONCLUSION HFNC is feasible to use for children with respiratory distress; however, patients with congenital heart disease, using HFNC with FiO2 > 0.6, lobar infiltration on chest X-ray should be closely monitored. Heart rate and respiratory rate are important parameters in addition to clinical assessment for evaluating HFNC failure in children.
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Affiliation(s)
- Kanokkarn Sunkonkit
- Division of Pulmonary and Critical Care, Department of Pediatrics, Faculty of MedicineChiang Mai UniversityChiang MaiThailand
| | - Supakanya Kungsuwan
- Division of Pulmonary and Critical Care, Department of Pediatrics, Faculty of MedicineChiang Mai UniversityChiang MaiThailand
| | - Sukanlaya Seetaboot
- Division of Pulmonary and Critical Care, Department of Pediatrics, Faculty of MedicineChiang Mai UniversityChiang MaiThailand
| | - Sanit Reungrongrat
- Division of Pulmonary and Critical Care, Department of Pediatrics, Faculty of MedicineChiang Mai UniversityChiang MaiThailand
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Itdhiamornkulchai S, Preutthipan A, Vaewpanich J, Anantasit N. Modified high-flow nasal cannula for children with respiratory distress. Clin Exp Pediatr 2022; 65:136-141. [PMID: 34044481 PMCID: PMC8898618 DOI: 10.3345/cep.2020.01403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 05/13/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND High-flow nasal cannula (HFNC) is a noninvasive respiratory support that provides the optimum flow of an air-oxygen mixture. Several studies demonstrated its usefulness and good safety profile for treating pediatric respiratory distress patients. However, the cost of the commercial HFNC is high; therefore, the modified high-flow nasal cannula was developed. PURPOSE This study aimed to compare the effectiveness, safety, and nurses' satisfaction of the modified system versus the standard commercial HFNC. METHODS This prospective comparative study was performed in a tertiary care hospital. We recruited children aged 1 month to 5 years who developed acute respiratory distress and were admitted to the pediatric intensive care unit. Patients were assigned to 2 groups (modified vs. commercial). The effectiveness and safety assessments included vital signs, respiratory scores, intubation rate, adverse events, and nurses' satisfaction. RESULTS A total of 74 patients were treated with HFNC. Thirty- nine patients were assigned to the modified group, while the remaining 35 patients were in the commercial group. Intubation rate and adverse events did not differ significantly between the 2 groups. However, the commercial group had higher nurses' satisfaction scores than the modified group. CONCLUSION Our findings suggest that our low-cost modified HFNC could be a useful respiratory support option for younger children with acute respiratory distress, especially in hospital settings with financial constraints.
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Affiliation(s)
- Sarocha Itdhiamornkulchai
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Aroonwan Preutthipan
- Division of Pediatric Pulmonology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jarin Vaewpanich
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nattachai Anantasit
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Cheng AY, Simon HK, Miller J, Wetzel M, Zmitrovich A, Hebbar KB. Survey of Current Institutional Practices in the Use of High-Flow Nasal Cannula for Pediatric Patients. Pediatr Emerg Care 2022; 38:e151-e156. [PMID: 32658118 DOI: 10.1097/pec.0000000000002192] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES High-flow nasal cannula (HFNC) is an oxygen delivery device that provides heated humidified air with higher flow rates. The purpose of this survey is to look at institutional practice patterns of HFNC initiation, weaning, and disposition for pediatric patients across the United States. METHODS Survey was sent via electronic listservs to pediatric physicians in emergency medicine, hospital medicine, critical care, and urgent care. The questionnaire was divided into demographics and HFNC practices (initiation, management, and weaning). One response per institution was included in the analysis. RESULTS Two hundred twenty-four responses were included in the analysis, composed of 40% pediatric emergency medicine physicians, 46% pediatric hospitalists, 13% pediatric intensive care unit (PICU) physicians, and 1% pediatric urgent care physicians. Ninety-eight percent of the participants have HFNC at their institution. Thirty-seven percent of the respondents had a formal guideline for HFNC initiation. Nearly all guideline and nonguideline institutions report HFNC use in bronchiolitis. Guideline cohort is more likely to have exclusion criteria for HFNC (42% in the guideline cohort vs 17% in the nonguideline cohort; P < 0.001) and less frequently mandates PICU admissions once on HFNC (11% in the guideline cohort vs 56% in the nonguideline cohort; P < 0.001). Forty-six percent of guideline cohort had an objective scoring system to help determine the need for HFNC, and 73% had a weaning guideline. CONCLUSIONS Although there is general agreement to use HFNC in bronchiolitis, great practice variation remains in the initiation, management, and weaning of HFNC across the United States. There is also a discordance on PICU use when a patient is using HFNC.
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Risk Factors Associated with Mechanical Ventilation in Critical Bronchiolitis. CHILDREN 2021; 8:children8111035. [PMID: 34828749 PMCID: PMC8618830 DOI: 10.3390/children8111035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/06/2021] [Accepted: 11/09/2021] [Indexed: 11/17/2022]
Abstract
The American Academy of Pediatrics (AAP) recommends supportive care for the management of bronchiolitis. However, patients admitted to the intensive care unit with severe (critical) bronchiolitis define a unique group with varying needs for both non-invasive and invasive respiratory support. Currently, no guidance exists to help clinicians discern who will progress to invasive mechanical support. Here, we sought to identify key clinical features that distinguish pediatric patients with critical bronchiolitis requiring invasive mechanical ventilation from those that did not. We conducted a retrospective cohort study at a tertiary pediatric medical center. Children ≤2 years old admitted to the pediatric intensive care unit (PICU) from January 2015 to December 2019 with acute bronchiolitis were studied. Patients were divided into non-invasive respiratory support (NRS) and invasive mechanical ventilation (IMV) groups; the IMV group was further subdivided depending on timing of intubation relative to PICU admission. Of the 573 qualifying patients, 133 (23%) required invasive mechanical ventilation. Median age and weight were lower in the IMV group, while incidence of prematurity and pre-existing neurologic or genetic conditions were higher compared to the NRS group. Multi-microbial pneumonias were diagnosed more commonly in the IMV group, in turn associated with higher severity of illness scores, longer PICU lengths of stay, and more antibiotic usage. Within the IMV group, those intubated earlier had a shorter duration of mechanical ventilation and PICU length of stay, associated with lower pathogen load and, in turn, shorter antibiotic duration. Taken together, our data reveal that critically ill patients with bronchiolitis who require mechanical ventilation possess high risk features, including younger age, history of prematurity, neurologic or genetic co-morbidities, and a propensity for multi-microbial infections.
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Novak C, Vomiero G, de Caen A, Cooke S. Current practices and policies regarding the use of high-flow nasal cannula on general pediatric inpatient wards in Canada. Paediatr Child Health 2021; 26:414-420. [PMID: 34777659 PMCID: PMC8581525 DOI: 10.1093/pch/pxab013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/11/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES High-flow nasal cannula (HFNC) oxygen therapy has become a common treatment for respiratory conditions in children. To our knowledge, no study has described practice patterns for HFNC on pediatric inpatient wards in Canada. The aim of this study was to survey current practices and policies regarding the use of HFNC on the ward in children's hospitals in Canada. METHODS We conducted a web-based survey of Pediatric Hospital Medicine section chiefs in major tertiary care hospitals in Canada. The primary outcome was the proportion of hospitals that use HFNC on the general pediatric ward. Secondary outcomes included indications for HFNC, initial and maximum flow rates, maximum FiO2, method of nutrition delivery while on HFNC, level of nursing and respiratory therapist care required, criteria for pediatric intensive care unit transfer, and subjective successes and challenges of implementing a ward-based HFNC policy. RESULTS The section chief survey response rate was 100% (15/15). Eight centres (53%) allowed the use of HFNC outside of an intensive care setting. Six centres initiated HFNC on the ward, while two centres only accepted patients after HFNC had been initiated in an intensive care setting. Other practices and policies varied considerably from centre to centre. CONCLUSION Our study reveals that approximately half of tertiary children's hospitals in Canada currently use HFNC on the ward and utilize a range of practices and policies. Other centres are considering implementation. Further research is needed to inform best practices for HFNC therapy, support stewardship of health care resources, and promote safe patient care.
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Affiliation(s)
- Chris Novak
- Stollery Children’s Hospital, Edmonton, Alberta, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Alberta Children’s Hospital, Calgary, Alberta, Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Gemma Vomiero
- Alberta Children’s Hospital, Calgary, Alberta, Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Allan de Caen
- Stollery Children’s Hospital, Edmonton, Alberta, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Suzette Cooke
- Alberta Children’s Hospital, Calgary, Alberta, Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
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Pierantoni L, Dondi A, Biagi C, Scozzarella A, Camela F, Lanari MA. Subcutaneous emphysema of the neck as a complication of high flow nasal cannula therapy in children: a case report. EMERGENCY CARE JOURNAL 2021. [DOI: 10.4081/ecj.2021.9615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
High Flow Nasal Cannula (HFNC) is a noninvasive technique for respiratory support increasingly used in the pediatric wards for the management of respiratory failure. Few data are reported about the safety of HFNC. We describe the case of a 3-months-old infant admitted for acute bronchiolitis Respiratory Syncyctial Virus-related and treated with HFNC for severe respiratory distress. 12 hours after the beginning of HFNC a subcutaneous swelling of the neck, attributable to subcutaneous emphysema, became clinically evident. Radiological imaging showed pneumomediastinum with air leaking up to the neck. Patient was moved to PICU where he further worsened due to a mediastinal shift requiring drainage and mechanical ventilation. He was then progressively weaned from ventilation and was discharged from the hospital. Pneumomediastinum may occur during HFNC, particularly in moderate-severe cases of acute bronchiolitis. Patients undergoing HFNC should be strictly monitored in order to promptly recognize this complication and treat the child appropriately.
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Asseri AA, AlQahtani YA, Alhanshani AA, Ali GH, Alhelali I. Indications and Safety of High Flow Nasal Cannula in Pediatric Intensive Care Unit: Retrospective Single Center Experience in Saudi Arabia. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2021; 12:431-437. [PMID: 34512073 PMCID: PMC8418355 DOI: 10.2147/phmt.s321536] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/19/2021] [Indexed: 11/23/2022]
Abstract
Background High flow nasal cannula (HFNC) is a new device for respiratory support. Its use continues to increase in pediatrics as its system is easily set up and well tolerated by patients. We aimed in this study to explore indications and safety of HFNC use and predictors of HFNC failure. Methods Hospital records of 92 children with acute respiratory distress admitted to the pediatric intensive care unit (PICU) in Abha Maternity and Children Hospital from January 2018 until March 2020 and received HFNC therapy were studied. A data collection sheet was used that included patients’ age, gender, the indication of HFNC, associated chronic diseases, previous admission to PICU, vital signs (initially, 8 hours and 48 hours after using HFNC), outcome after using HFNC, and reasons for HFNC failure. Results After receiving HFNC, children’s respiratory rate, heart rate, systolic blood pressure, and oxygen saturation improved significantly (p < 0.001, p < 0.001, p < 0.001, p = 0.005, and p < 0.001, respectively). Regarding laboratory findings, pH and serum bicarbonate improved significantly (p < 0.001 for both), while PaCO2 improved but not significantly. The failure rate of HFNC was 23.0%. HFNC failure rates were significantly higher among children with chronic diseases than those with no chronic disease (33.3% and 14.9%, respectively, p = 0.038) and among children with the air-leak syndrome (p < 0.001). After 48 hours of HFNC use, children who experienced HFNC failure had significantly higher respiratory and heart rates (p < 0.001 and p = 0.018, respectively), lower diastolic blood pressure (p = 0.011), and higher PaCO2 (p < 0.001). Conclusion After HFNC use, significant improvements occur in all clinical parameters and laboratory values of children with respiratory distress, but about one-fourth of cases may experience HFNC failure. Predictors for HFNC failure include underlying chronic disease, low diastolic blood pressure, high respiratory rate, high heart rate, high initial PaCO2.
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Affiliation(s)
- Ali Alsuheel Asseri
- Department of Child Health, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Youssef Ali AlQahtani
- Department of Child Health, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Ahmad Ali Alhanshani
- Department of Child Health, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Ghada Haider Ali
- Department of Pediatrics, Abha Maternity and Children Hospital, Abha, Saudi Arabia
| | - Ibrahim Alhelali
- Department of Pediatrics, Abha Maternity and Children Hospital, Abha, Saudi Arabia
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16
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Bobillo-Perez S, Sorribes C, Gebellí P, Lledó N, Castilla M, Ramon M, Rodriguez-Fanjul J. Lung ultrasound to predict pediatric intensive care admission in infants with bronchiolitis (LUSBRO study). Eur J Pediatr 2021; 180:2065-2072. [PMID: 33585977 DOI: 10.1007/s00431-021-03978-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/26/2021] [Accepted: 02/02/2021] [Indexed: 01/01/2023]
Abstract
It is extremely difficult to stratify bronchiolitis and predict the need for admission to the pediatric intensive care unit (PICU). We aimed to evaluate the capacity of a new lung ultrasound score (LUSBRO) to predict the need for admission to the PICU compared to a clinical score. This was a prospective observational single-center study that includes infants < 6 month of age admitted to a hospital due to acute bronchiolitis. Both scores were calculated at admission. The main outcome was PICU admission. Second endpoints were the need for mechanical ventilation, respiratory support duration, and the length of stay in the hospital. Eighty patients were included, with a median age of 53 days (IQR 29-115). Forty-four patients (55%) required PICU admission. LUSBRO score showed a better AUC compared to the clinical score to predict PICU admission: 0.932 (95% CI 0.873-0.990) vs. 0.675 (95% CI 0.556-0.794) and a positive correlation with the hospital length of stay. The best cut-off point for predicting the need for PICU admission for LUSBRO score was 6, showing a sensitivity of 90.91% and a specificity of 88.89%.Conclusions: The LUSBRO score is a useful tool to predict the need for admission to the PICU. What is Known • It is extremely difficult to stratify which patients affected by bronchiolitis should be precociously transferred to a third level hospital and will require pediatric intensive care unit (PICU) admission. • Clinical scores have been created but neither of them is accurate. What is New • The LUSBRO score is a useful tool to predict the need for admission to the PICU of patients with bronchiolitis and, consequently, to predict the patients who should be transferred to a tertiary hospital to optimize respiratory support.
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Affiliation(s)
- Sara Bobillo-Perez
- Disorders of Immunity and Respiration of the Paediatric Critical Patient Research Group, Institut Recerca Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.,Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Clara Sorribes
- Pediatric Intensive Care Unit, Paediatric Department, Hospital Joan XXIII, Tarragona, Spain
| | - Paula Gebellí
- Pediatric Intensive Care Unit, Paediatric Department, Hospital Joan XXIII, Tarragona, Spain
| | - Nuria Lledó
- Pediatric Intensive Care Unit, Paediatric Department, Hospital Joan XXIII, Tarragona, Spain
| | - Marta Castilla
- Pediatric Intensive Care Unit, Paediatric Department, Hospital Joan XXIII, Tarragona, Spain
| | - Miquel Ramon
- Pediatric Intensive Care Unit, Paediatric Department, Hospital Joan XXIII, Tarragona, Spain
| | - Javier Rodriguez-Fanjul
- Neonatology Unit, Paediatric Department, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Carretera de Canyet, s/n, 08916 Badalona, Barcelona, Spain.
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Iplik G, Yildizdas D, Yontem A. Clinical Factors of High-Flow Nasal Cannula Oxygen Success in Children. J Pediatr Intensive Care 2021; 12:71-78. [PMID: 36742258 PMCID: PMC9894699 DOI: 10.1055/s-0041-1730915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/08/2021] [Indexed: 02/07/2023] Open
Abstract
This study was aimed to evaluate the success rate of high-flow nasal cannula (HFNC) oxygen therapy and factors causing therapy failure. This prospective observational study included 131 children who received HFNC oxygen and followed-up in the pediatric emergency department, pediatric clinics, and pediatric intensive care unit between March 2018 and December 2019. The median age was 23.0 months (interquartile range [IQR]: 9.0-92.0) and 65 patients were male (49.6%). The most common reason for requiring HFNC oxygen therapy was pneumonia ( n = 75, 57.3%). A complex chronic condition was present in 112 (85.5%) patients. Therapy success was achieved in 116 patients (88.5%). The reason for requiring treatment and the patients' complex chronic condition did not affect the success of the therapy ( p = 0.294 and 0.091, respectively). In the first 24 hours of treatment, a significant improvement in pulse rate, respiratory rate, pH, and lactate level were observed in successful HFNC oxygen patients ( p < 0.05). In addition, these patients showed a significant improvement in SpO 2 and SpO 2 /FiO 2 ratio, and a significant decrease in FiO 2 and flow rate ( p < 0.05). HFNC oxygen success rate was 95.6% in patients with SpO 2 /FiO 2 ≥ 150 at the 24th hour; it was 58.0% in those with SpO 2 /FiO 2 < 150 ( p < 0.001). Caution should be exercised in terms of HFNC oxygen failure in patients with no significant improvement in vital signs and with SpO 2 /FiO 2 < 150 during treatment.
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Affiliation(s)
- Gokce Iplik
- Division of Pediatric Intensive Care Unit, Çukurova University Faculty of Medicine, Sarıçam, Adana, Turkey,Address for correspondence Gokce Iplik, MD Division of Pediatric Intensive Care Unit, Çukurova University Faculty of MedicineSarıçam, AdanaTurkey
| | - Dincer Yildizdas
- Division of Pediatric Intensive Care Unit, Çukurova University Faculty of Medicine, Sarıçam, Adana, Turkey
| | - Ahmet Yontem
- Division of Pediatric Intensive Care Unit, Çukurova University Faculty of Medicine, Sarıçam, Adana, Turkey
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18
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Nascimento MS, Quinto DER, Zamberlan GC, Santos AZD, Rebello CM, Prado CD. High-flow nasal cannula failure: can clinical outcomes determine early interruption? EINSTEIN-SAO PAULO 2021; 19:eAO5846. [PMID: 34133643 PMCID: PMC8225260 DOI: 10.31744/einstein_journal/2021ao5846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 11/11/2020] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the evolution of clinical outcomes in children with bronchiolitis who used a high-flow nasal cannula, and to determine after long of non-clinical improvement the therapy should be discontinued, and treatment should be escalated to other forms of ventilatory support. METHODS An observational retrospective study of infants with bronchiolitis who used a high-flow nasal cannula. Patients were divided into two study groups according to success or failure of high-flow nasal cannula therapy, namely the Success Group and the Failure Group. The main demographics and clinical variables were assessed 30 minutes and 6 hours after initiating therapy until removal of the high-flow nasal cannula. RESULTS A total of 83 children were studied and 18 children (21.7%) failed therapy. Among subjects with successful therapy, a significant decrease in respiratory rate (p<0.001), and a significant increase in peripheral oxygen saturation (p<0.001) were observed within 30 minutes. The Success Group was significantly different from the Failure Group after 6 hours, for both respiratory rate (p<0.01) and peripheral oxygen saturation (p<0.01). CONCLUSION The absence of clinical sign improvement within 30 minutes and for up to a maximum of 6 hours can be considered as failure of the high-flow nasal cannula therapy. If this time elapses with no improvements, escalating to another type of ventilatory support should be considered.
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Tortosa F, Izcovich A, Carrasco G, Varone G, Haluska P, Sanguine V. High-flow oxygen nasal cannula for treating acute bronchiolitis in infants: A systematic review and meta-analysis. Medwave 2021; 21:e8190. [PMID: 34086669 DOI: 10.5867/medwave.2021.04.8190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/29/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction Oxygen therapy through a high-flow nasal cannula is thought to improve the work of breathing and the comfort of patients with acute bronchiolitis. It is widely used in hospital wards and critical care of pediatric patients. However, there is uncertainty on the magnitude of the effect on critical and important outcomes in these patients. Objectives The objective of this review is to evaluate the available evidence on the use of oxygen administered through high-flow cannula versus low-flow oxygen for the treatment of acute bronchiolitis in children under two years of age. Methodology We carried out a systematic review and a meta-analysis following the PRISMA standards for reporting. The search was carried out in electronic databases by two researchers independently. The evidence was summarized using the GRADE methodology. Results Six randomized and non-randomized clinical trials were included, including 1867 individuals younger than 24 months of age with acute bronchiolitis in pediatric emergency, hospitalization, and intensive care services. Mortality was not reported in the included studies. Treatment failure occurred in 108/933 in the high flow group and 233/934 in the low flow group (relative risk: 0.46; 95% confidence interval: 0.35 to 0.62), which shows 11.7% less treatment failure (95% confidence interval between 7.9% and 14.5% less) in the high flow group with a number needed to treat of 7.5 (95% confidence interval 6 to 10) with moderate certainty in the evidence. Conclusion The use of humidified and heated oxygen with high flow compared to oxygen at low flow is probably associated with decreased treatment failure in children younger than two years with acute bronchiolitis. There is uncertainty about the effect on hospitalization days and clinical progression.
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Affiliation(s)
- Fernando Tortosa
- Comité de Evaluación de Biotecnologías, Ministerio de Salud, Río Negro, Argentina; Red Argentina Pública de Evaluación de Tecnologías Sanitarias, Neuquén, Argentina; Departamento de Docencia e Investigación, Hospital Zonal Ramón Carrillo de Bariloche, Río Negro, Argentina. Dirección: Moreno 601, San Carlos de Bariloche, Río Negro, Argentina. . ORCID: 0000-0002-0303-6055
| | - Ariel Izcovich
- Servicio de Clínica Médica, Hospital Alemán, Buenos Aires, Argentina. ORCID: 0000-0001-9053-4396
| | - Gabriela Carrasco
- Red Argentina Pública de Evaluación de Tecnologías Sanitarias, Neuquén, Argentina. ORCID: 0000-0002-8039-6345
| | - Gabriela Varone
- Departamento de Docencia e Investigación, Hospital Zonal Ramón Carrillo de Bariloche, Río Negro, Argentina; División Pediatría, Hospital Zonal Ramón Carrillo de Bariloche, Río Negro, Argentina. ORCID: 0000-0002-6460-5645
| | - Pedro Haluska
- Departamento de Docencia e Investigación, Hospital Zonal Ramón Carrillo de Bariloche, Río Negro, Argentina. ORCID: 0000-0002-5086-0880
| | - Verónica Sanguine
- Dirección Nacional de Calidad en Servicios de Salud y Regulación Sanitaria, Ministerio de Salud de la Nación, Buenos Aires, Argentina. ORCID: 0000-0002-4842-0528
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20
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Vo AT, Liu DR, Schmidt AR, Festekjian A. Capillary blood gas in infants with bronchiolitis: Can end-tidal capnography replace it? Am J Emerg Med 2021; 45:144-148. [PMID: 33915447 DOI: 10.1016/j.ajem.2021.04.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To explore the predictive ability of capillary blood gas (CBG) pCO2 for respiratory decompensation in infants aged ≤6 months with bronchiolitis admitted from the emergency department; to determine whether end-tidal CO2 (etCO2) capnography can serve as a less invasive substitute for CBG pCO2. STUDY DESIGN This was a prospective cohort study of previously healthy infants aged ≤6 months admitted for bronchiolitis from the emergency department (ED). Initial CBG pCO2 and etCO2 capnography were obtained in the ED prior to inpatient admission. Simple logistic regression modeling was used to examine the associations of CBG pCO2 and etCO2 capnography with respiratory decompensation. Pearson's correlation measured the relationship between CBG pCO2 and etCO2 capnography. RESULTS Of 134 patients, 61 had respiratory decompensation. There was a significant association between CBG pCO2 and respiratory decompensation (OR = 1.07, p = 0.003), even after outlying values were excluded (OR = 1.06, p = 0.005). End tidal CO2 capnography was not significantly associated with decompensation (OR = 1.02, p = 0.17), even after outlying values were excluded (OR = 1.02, p = 0.24). There was a moderate correlation between etCO2 capnography and CBG pCO2 (r = 0.39, p < 0.001). CONCLUSION In infants with bronchiolitis, CBG pCO2 provides an objective measure for predicting respiratory decompensation, and a single etCO2 measurement should not replace its use.
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Affiliation(s)
- Andrea T Vo
- Department of Pediatrics, Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd MS#113, LA, California 90027, USA.
| | - Deborah R Liu
- Department of Pediatrics, Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd MS#113, LA, California 90027, USA.
| | - Anita R Schmidt
- Department of Pediatrics, Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd MS#113, LA, California 90027, USA.
| | - Ara Festekjian
- Department of Pediatrics, Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd MS#113, LA, California 90027, USA.
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Franklin D, Shellshear D, Babl FE, Hendrickson R, Williams A, Gibbons K, McEnery K, Kennedy M, Pham TM, Acworth J, Levitt D, Oakley E, Schibler A. High flow in children with respiratory failure: A randomised controlled pilot trial - A paediatric acute respiratory intervention study. J Paediatr Child Health 2021; 57:273-281. [PMID: 33377568 DOI: 10.1111/jpc.15259] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 10/07/2020] [Accepted: 10/24/2020] [Indexed: 11/28/2022]
Abstract
AIMS High-flow is increasingly used in children with acute hypoxaemic respiratory failure (AHRF), despite limited evidence. The primary feasibility endpoint for this pilot-study was the proportion of treatment failure, secondary outcomes being intensive care unit (ICU) admissions and proportion of patients requiring escalation of care. We measured duration of hospital stay, duration of oxygen therapy and rates of ICU admission. METHODS An open-labelled randomised controlled trial feasibility design was used in two tertiary children's hospitals in the emergency department and general wards. Children aged 0-16 years with AHRF were randomised (1:1) to either high-flow or standard-oxygen. Children on standard-oxygen received rescue high-flow in general wards if failure criteria were met. RESULTS Of 563 randomised, 283 received high-flow and 280 standard-oxygen with no adverse events. The proportion of children who failed treatment and receiving escalation of care was 11.7% (32/283 children) on high-flow and 18.1% (50/280 infants) on standard-oxygen (odds ratio 0.68, 95% confidence interval 0.38-1.00). In children with obstructive airway disease, 9.7% on high-flow and 17.4% on standard-oxygen required escalation (risk-difference -7.7% percentage points; 95% confidence interval -14.3, -1.1); in children with non-obstructive disease no difference was observed. Neither difference in ICU admissions nor any difference in length of hospital stay was observed. Sixty percent of children who failed standard-oxygen responded to rescue high-flow. CONCLUSION High-flow outside ICU appears to be feasible in children with AHRF and the required proportion of escalation was lower compared to standard-oxygen. The trial design can be applied in a future large randomised controlled trial.
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Affiliation(s)
- Donna Franklin
- Gold Coast University Hospital, Emergency Department Collaborative Research Group, Southport, Australia.,The University of Queensland, Paediatric Critical Care Research Group, Child Health Research Centre, School of Medicine, South Brisbane, Australia.,PREDICT (Paediatric Research in Emergency Departments International Collaborative), Parkville, Victoria, Australia
| | - Deborah Shellshear
- Queensland Children's Hospital, Brisbane, Australia.,PREDICT (Paediatric Research in Emergency Departments International Collaborative), Parkville, Victoria, Australia.,Paediatric Emergency Department, Children's Health Queensland and Health Services, Brisbane, Queensland, Australia
| | - Franz E Babl
- PREDICT (Paediatric Research in Emergency Departments International Collaborative), Parkville, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Emergency Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Rikki Hendrickson
- Queensland Children's Hospital, Brisbane, Australia.,Paediatric Emergency Department, Children's Health Queensland and Health Services, Brisbane, Queensland, Australia
| | - Amanda Williams
- PREDICT (Paediatric Research in Emergency Departments International Collaborative), Parkville, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Emergency Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Kristen Gibbons
- The University of Queensland, Paediatric Critical Care Research Group, Child Health Research Centre, School of Medicine, South Brisbane, Australia.,Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Kate McEnery
- The University of Queensland, Paediatric Critical Care Research Group, Child Health Research Centre, School of Medicine, South Brisbane, Australia
| | - Melanie Kennedy
- Queensland Children's Hospital, Brisbane, Australia.,The University of Queensland, Paediatric Critical Care Research Group, Child Health Research Centre, School of Medicine, South Brisbane, Australia
| | - Trang Mt Pham
- The University of Queensland, Paediatric Critical Care Research Group, Child Health Research Centre, School of Medicine, South Brisbane, Australia
| | - Jason Acworth
- Queensland Children's Hospital, Brisbane, Australia.,PREDICT (Paediatric Research in Emergency Departments International Collaborative), Parkville, Victoria, Australia.,Paediatric Emergency Department, Children's Health Queensland and Health Services, Brisbane, Queensland, Australia
| | - David Levitt
- Queensland Children's Hospital, Brisbane, Australia.,Department of Paediatrics, Children's Health Queensland and Health Services, South Brisbane, Queensland, Australia
| | - Ed Oakley
- PREDICT (Paediatric Research in Emergency Departments International Collaborative), Parkville, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Emergency Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Andreas Schibler
- Queensland Children's Hospital, Brisbane, Australia.,The University of Queensland, Paediatric Critical Care Research Group, Child Health Research Centre, School of Medicine, South Brisbane, Australia.,PREDICT (Paediatric Research in Emergency Departments International Collaborative), Parkville, Victoria, Australia
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22
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Update on the Role of High-Flow Nasal Cannula in Infants with Bronchiolitis. CHILDREN-BASEL 2021; 8:children8020066. [PMID: 33498527 PMCID: PMC7909574 DOI: 10.3390/children8020066] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 11/17/2022]
Abstract
Bronchiolitis (BR), a lower respiratory tract infection mainly caused by respiratory syncytial virus (RSV), can be very severe. Presently, adequate nutritional support and oxygen therapy remain the only interventions recommended to treat patients with BR. For years, mild BR cases were treated with noninvasive standard oxygen therapy (SOT), i.e., with cold and poorly or totally non-humidified oxygen delivered by an ambient headbox or low-flow nasal cannula. Children with severe disease were intubated and treated with invasive mechanical ventilation (IMV). To improve SOT and overcome the disadvantages of IMV, new measures of noninvasive and more efficient oxygen administration have been studied. Bi-level positive air way pressure (BiPAP), continuous positive airway pressure (CPAP), and high-flow nasal cannula (HFNC) are among them. For its simplicity, good tolerability and safety, and the good results reported in clinical studies, HFNC has become increasingly popular and is now widely used. However, consistent guidelines for initiation and discontinuation of HFNC are lacking. In this narrative review, the role of HFNC to treat infants with BR is discussed. An analysis of the literature showed that, despite its widespread use, the role of HFNC in preventing respiratory failure in children with BR is not precisely defined. It is not established whether it can offer greater benefits compared to SOT and when and in which infants it can replace CPAP or BiPAP. The analysis of the results clearly indicates the need for multicenter studies and official guidelines. In the meantime, HFNC can be considered a safe and effective method to treat children with mild to moderate BR who do not respond to SOT.
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Fabre C, Panciatici M, Sauvaget E, Tardieu S, Jouve E, Dequin M, Retornaz K, Bartoli JM, Stremler-Le Bel N, Bosdure E, Dubus JC. Real-life study of the role of high-flow nasal cannula for bronchiolitis in children younger than 3 months hospitalised in general pediatric departments. Arch Pediatr 2020; 28:1-6. [PMID: 33342682 DOI: 10.1016/j.arcped.2020.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 08/18/2020] [Accepted: 11/15/2020] [Indexed: 10/22/2022]
Abstract
We aimed to describe the real-life role of high-flow nasal cannula (HFNC) for bronchiolitis in infants under 3 months of age admitted to three general pediatric departments during the 2017-2018 epidemic period. We retrospectively assessed the clinical severity (Wang score) for every 24-h period of treatment (H0-H24 and H24-H48) according to the initiated medical care (HFNC, oxygen via nasal cannula, or supportive treatments only), the child's discomfort (EDIN score), and transfer to the pediatric intensive care unit (PICU). A total of 138 infants were included: 47±53 days old, 4661±851.9 g, 70 boys (50.7%), 58 with hypoxemia (42%), Wang score of 6.67±2.58, 110 (79.7%) staying for 48 consecutive hours in the same ward. During the H0-H24 period, only patients treated with HFNC had a statistically significant decrease in the severity score (n=21/110; -2 points, P=0.002) and an improvement in the discomfort score (n=15/63; -3.8 points, P<0.0001). There was no difference between groups during the H24-H48 period. The rate of admission to the PICU was 2.9% for patients treated for at least 24 h with HFNC (n=34/138, 44% with oxygen) versus 16.3% for the others (P=0.033). Early use of HFNC improves both clinical status and discomfort in infants younger than 3 months admitted for moderately severe bronchiolitis, whatever their oxygen status.
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Affiliation(s)
- C Fabre
- Service de médecine infantile et pneumologie pédiatrique, CHU Timone-enfants, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France; Aix-Marseille université, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, 43, boulevard Baille, 13005 Marseille, France
| | - M Panciatici
- Service de médecine infantile et pneumologie pédiatrique, CHU Timone-enfants, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France; Aix-Marseille université, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, 43, boulevard Baille, 13005 Marseille, France
| | - E Sauvaget
- Service de pédiatrie, hôpital Saint-Joseph, 26, boulevard de Louvain, 13008 Marseille, France; Aix-Marseille université, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, 43, boulevard Baille, 13005 Marseille, France
| | - S Tardieu
- Service d'évaluation médicale, pôle de santé publique, hôpital de la Conception, 147, boulevard Baille, 13055 Marseille, France; Aix-Marseille université, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, 43, boulevard Baille, 13005 Marseille, France
| | - E Jouve
- Service d'évaluation médicale, pôle de santé publique, hôpital de la Conception, 147, boulevard Baille, 13055 Marseille, France; Aix-Marseille université, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, 43, boulevard Baille, 13005 Marseille, France
| | - M Dequin
- Service de médecine infantile et pneumologie pédiatrique, CHU Timone-enfants, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France; Aix-Marseille université, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, 43, boulevard Baille, 13005 Marseille, France
| | - K Retornaz
- Service de pédiatrie, hôpital Nord, chemin des Bourrely, 13015 Marseille, France; Aix-Marseille université, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, 43, boulevard Baille, 13005 Marseille, France
| | - J-M Bartoli
- Service de pédiatrie, hôpital Saint-Joseph, 26, boulevard de Louvain, 13008 Marseille, France; Aix-Marseille université, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, 43, boulevard Baille, 13005 Marseille, France
| | - N Stremler-Le Bel
- Service de médecine infantile et pneumologie pédiatrique, CHU Timone-enfants, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France; Aix-Marseille université, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, 43, boulevard Baille, 13005 Marseille, France
| | - E Bosdure
- Service de médecine infantile et pneumologie pédiatrique, CHU Timone-enfants, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France; Aix-Marseille université, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, 43, boulevard Baille, 13005 Marseille, France
| | - J-C Dubus
- Service de médecine infantile et pneumologie pédiatrique, CHU Timone-enfants, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France; Aix-Marseille université, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, 43, boulevard Baille, 13005 Marseille, France.
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24
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Kamit F, Anil M, Anil AB, Berksoy E, Gokalp G. Preemptive high-flow nasal cannula treatment in severe bronchiolitis: Results from a high-volume, resource-limited pediatric emergency department. Pediatr Int 2020; 62:1339-1345. [PMID: 32469101 DOI: 10.1111/ped.14325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 05/13/2020] [Accepted: 05/22/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aims of this study were to evaluate the outcomes of patients with severe bronchiolitis who received preemptive high-flow nasal cannula (HFNC) treatment according to the authors' protocol, and to identify potential baseline characteristics that might predict patients who will not benefit from HFNC. METHODS This was a retrospective chart review of patients with severe bronchiolitis, who received preemptive HFNC treatment according to the authors' protocol and who were admitted to the pediatric emergency department between January 1, 2015, and December 31, 2016. RESULTS Eighty-four patients in total were enrolled over the 2 year period. Twenty-three patients (27.3%) failed HFNC. Of these, four responded to non-invasive mechanical ventilation and 19 required subsequent invasive ventilation. According to logistic regression analysis, existence of a chronic condition, significant tachycardia, existence of dehydration, and a venous pH <7.30 at admission were found to be predictors of HFNC failure. There were no cases of pneumothorax or any other reported adverse effects related to HFNC therapy. CONCLUSIONS Preemptive HFNC treatment, complying with a preestablished protocol, might be a safe way to support patients with severe bronchiolitis in high-volume, resource-limited pediatric emergency departments. The existence of a chronic condition, significant tachycardia, dehydration, and a venous pH <7.30 at admission could be risk factors for preemptive HFNC treatment failure in severe bronchiolitis.
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Affiliation(s)
- Fulya Kamit
- Pediatric Intensive Care Unit, Tepecik Teaching and Research Hospital, Izmir, Turkey
| | - Murat Anil
- Pediatric Emergency Department, Tepecik Teaching and Research Hospital, Izmir, Turkey
| | - Ayse Berna Anil
- Pediatric Intensive Care Unit, Tepecik Teaching and Research Hospital, Izmir Katip Celebi University, Medical School, Izmir, Turkey
| | - Emel Berksoy
- Pediatric Emergency Department, Tepecik Teaching and Research Hospital, Izmir, Turkey
| | - Gamze Gokalp
- Pediatric Emergency Department, Tepecik Teaching and Research Hospital, Izmir, Turkey
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25
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Richards M, Le Roux D, Cooke L, Argent A. The Influence of High Flow Nasal Cannulae on the Outcomes of Severe Respiratory Disease in Children Admitted to a Regional Hospital in South Africa. J Trop Pediatr 2020; 66:612-620. [PMID: 32533147 DOI: 10.1093/tropej/fmaa024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In settings where access to paediatric intensive care unit (PICU) facilities is constrained and transfer capacity is limited, High Flow Nasal Cannulae (HFNC) might fill an important service gap. The aim of this study was to document the effect of HFNC on the outcomes of children admitted with severe respiratory disease at a regional hospital without a PICU in Cape Town, South Africa. It is a 4-year retrospective analysis documenting two periods of 2 years each, one before (2013-15) and one after (2016-18) the initiation of HFNC use. Patients were between the ages of 2 months and 13 years and had been admitted to a paediatric ward. Outcomes were defined by the need for transfer to a tertiary hospital, the need for invasive ventilation and death. There were 90 instances of HFNC use with a significant reduction in the number of children who were transferred (59 vs. 31), invasively ventilated (20 vs. 6, p ≤ 0.01) and who died (3 vs. 0, p = 0.02). Before HFNC implementation, there was also a significantly greater proportion of transferred children who remained on low flow nasal cannulae (15 vs. 2, p ≤ 0.001) at the tertiary hospital. Children who failed HFNC use tended to do this within a day of initiation (Median 11 vs. 60 h for success, p ≤ 0.001). There were no complications related to its use. We believe that in our setting the utilization of HFNC has helped to timeously and accurately identify children needing to be transferred and may mitigate against severe respiratory disease progression.
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Affiliation(s)
- Mark Richards
- Department of Paediatrics and Child Health, New Somerset Hospital, Faculty of Health Sciences, University of Cape Town, 7700, Cape Town, South Africa
| | - David Le Roux
- Department of Paediatrics and Child Health, New Somerset Hospital, Faculty of Health Sciences, University of Cape Town, 7700, Cape Town, South Africa
| | - Louise Cooke
- Department of Paediatrics and Child Health, New Somerset Hospital, Faculty of Health Sciences, University of Cape Town, 7700, Cape Town, South Africa
| | - Andrew Argent
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Faculty of Health Sciences, University of Cape Town, 7700, Cape Town, South Africa
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26
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Zar HJ, Moore DP, Andronikou S, Argent AC, Avenant T, Cohen C, Green RJ, Itzikowitz G, Jeena P, Masekela R, Nicol MP, Pillay A, Reubenson G, Madhi SA. Diagnosis and management of community-acquired pneumonia in children: South African Thoracic Society guidelines. Afr J Thorac Crit Care Med 2020; 26:10.7196/AJTCCM.2020.v26i3.104. [PMID: 34471872 PMCID: PMC7433705 DOI: 10.7196/ajtccm.2020.v26i3.104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pneumonia remains a major cause of morbidity and mortality amongst South African children. More comprehensive immunisation regimens, strengthening of HIV programmes, improvement in socioeconomic conditions and new preventive strategies have impacted on the epidemiology of pneumonia. Furthermore, sensitive diagnostic tests and better sampling methods in young children improve aetiological diagnosis. OBJECTIVES To produce revised guidelines for pneumonia in South African children under 5 years of age. METHODS The Paediatric Assembly of the South African Thoracic Society and the National Institute for Communicable Diseases established seven expert subgroups to revise existing South African guidelines focusing on: (i) epidemiology; (ii) aetiology; (iii) diagnosis; (iv) antibiotic management and supportive therapy; (v) management in intensive care; (vi) prevention; and (vii) considerations in HIV-infected or HIVexposed, uninfected (HEU) children. Each subgroup reviewed the published evidence in their area; in the absence of evidence, expert opinion was accepted. Evidence was graded using the British Thoracic Society (BTS) grading system. Sections were synthesized into an overall guideline which underwent peer review and revision. RECOMMENDATIONS Recommendations include a diagnostic approach, investigations, management and preventive strategies. Specific recommendations for HIV infected and HEU children are provided. VALIDATION The guideline is based on available published evidence supplemented by the consensus opinion of SA paediatric experts. Recommendations are consistent with those in published international guidelines.
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Affiliation(s)
- H J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town, South Africa
- South African Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, South Africa
| | - D P Moore
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - S Andronikou
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town, South Africa
- Department of Pediatric Radiology, Perelman School of Medicine, University of Philadephia, USA
| | - A C Argent
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town, South Africa
| | - T Avenant
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, South Africa
| | - C Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - R J Green
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, South Africa
| | - G Itzikowitz
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town, South Africa
| | - P Jeena
- Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - R Masekela
- Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - M P Nicol
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, South Africa; and Division of Infection and Immunity, School of Biomedical Sciences, University of Western Australia, Perth, Australia
| | - A Pillay
- Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - G Reubenson
- Department of Paediatrics and Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - S A Madhi
- South African Medical Research Council Vaccine and Infectious Diseases Analytics Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: South African Research Chair in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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27
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Nasogastric tube, a warning sign for high-flow nasal cannula failure in infants with bronchiolitis. Sci Rep 2020; 10:15914. [PMID: 32985553 PMCID: PMC7522248 DOI: 10.1038/s41598-020-72687-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 08/31/2020] [Indexed: 11/09/2022] Open
Abstract
High-flow nasal cannula (HFNC) therapy is routinely used in the treatment of infants with bronchiolitis. This study sought to identify markers associated with failure of HFNC therapy that serve as warnings for early staging of other ventilatory support products. A retrospective study of infants with a diagnosis of bronchiolitis, receiving HFNC and admitted to the pediatric intensive care unit from January 2016 to June 2017, was conducted. The subjects were divided into two study groups according to the success or failure of HFNC therapy. Risk factors were assessed using the following variables: age, time between hospital admission and start of HFNC, equipment model, and the need for a nasogastric tube. Eighty-one infants were studied, and 18 (21.7%) of them exhibited therapy failure. The results of the logistic models showed that the chances of failure for patients requiring a nasogastric tube during HFNC use were more likely than those for patients with oral nutrition (OR = 8.17; 95% CI 2.30–28.99; p = 0.001). The HFNC failure was not associated with the device used (OR = 1.56; 95% CI 0.54–4.52; p = 0.41), time between hospital admission and HFNC installation (OR = 1.01; 95% CI 0.98–1.03; p = 0.73), or age (OR = 0.98; 95% CI 0.82–1.17; p = 0.82). Among late outcomes evaluated, the patients with therapy failure had longer total durations of O2 use (p < 0.001) and longer hospital stays (p < 0.001). The need to use a nasogastric tube during HFNC use was associated with HFNC therapy failure and can be considered as a marker of severity in children with bronchiolitis.
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28
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Babl FE, Franklin D, Schlapbach LJ, Oakley E, Dalziel S, Whitty JA, Neutze J, Furyk J, Craig S, Fraser JF, Jones M, Schibler A. Enteral hydration in high-flow therapy for infants with bronchiolitis: Secondary analysis of a randomised trial. J Paediatr Child Health 2020; 56:950-955. [PMID: 32043304 DOI: 10.1111/jpc.14799] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/22/2019] [Accepted: 01/05/2020] [Indexed: 11/29/2022]
Abstract
AIM Nasal high-flow oxygen therapy is increasingly used in infants for supportive respiratory therapy in bronchiolitis. It is unclear whether enteral hydration is safe in children receiving high-flow. METHODS We performed a planned secondary analysis of a multi-centre, randomised controlled trial of infants aged <12 months with bronchiolitis and an oxygen requirement. Children were assigned to treatment with either high-flow or standard-oxygen therapy with optional rescue high-flow. We assessed adverse events based on how children on high-flow were hydrated: intravenously (IV), via bolus or continuous nasogastric tube (NGT) or orally. RESULTS A total of 505 patients on high-flow via primary study assignment (n = 408), primary treatment (n = 10) or as rescue therapy (n = 87) were assessed. While on high flow, 15 of 505 (3.0%) received only IV fluids, 360 (71.3%) received only enteral fluids and 93 (18.4%) received both IV and enteral fluids. The route was unknown in 37 (7.3%). Of the 453 high-flow infants hydrated enterally patients could receive one or more methods of hydration; 80 (15.8%) received NGT bolus, 217 (43.0%) NGT continuous, 118 (23.4%) both bolus and continuous, 32 (6.3%) received only oral hydration and 171 (33.9%) a mix of NGT and oral hydration. None of the patients receiving oral or NGT hydration on high-flow sustained pulmonary aspiration (0%; 95% confidence interval N/A); one patient had a pneumothorax (0.2%; 95% confidence interval 0.0-0.7%). CONCLUSIONS The vast majority of children with hypoxic respiratory failure in bronchiolitis can be safely hydrated enterally during the period when they receive high-flow.
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Affiliation(s)
- Franz E Babl
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Donna Franklin
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia.,Pediatric Critical Care Research Group, Queensland Children's Hospital and The University of Queensland, Brisbane, Queensland, Australia.,Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Critical Care Research Group, Adult Intensive Care Service, The Prince Charles Hospital, Brisbane, Queensland, Australia.,Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Luregn J Schlapbach
- Pediatric Critical Care Research Group, Queensland Children's Hospital and The University of Queensland, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Critical Care Research Group, Adult Intensive Care Service, The Prince Charles Hospital, Brisbane, Queensland, Australia.,Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Ed Oakley
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Stuart Dalziel
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia.,Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand.,Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Jennifer A Whitty
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Jocelyn Neutze
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia.,Emergency Department, KidzFirst Middlemore Hospital, Auckland, New Zealand
| | - Jeremy Furyk
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia.,College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.,Emergency Department, The Townsville Hospital, Townsville, Queensland, Australia
| | - Simon Craig
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia.,Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.,Paediatric Emergency Department, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia
| | - John F Fraser
- Pediatric Critical Care Research Group, Queensland Children's Hospital and The University of Queensland, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Mark Jones
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Andreas Schibler
- Pediatric Critical Care Research Group, Queensland Children's Hospital and The University of Queensland, Brisbane, Queensland, Australia.,Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
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Vahlkvist S, Jürgensen L, la Cour A, Markoew S, Petersen TH, Kofoed PE. High flow nasal cannula and continuous positive airway pressure therapy in treatment of viral bronchiolitis: a randomized clinical trial. Eur J Pediatr 2020; 179:513-518. [PMID: 31828528 DOI: 10.1007/s00431-019-03533-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 11/14/2019] [Accepted: 11/19/2019] [Indexed: 01/06/2023]
Abstract
Continuous positive airway pressure (CPAP) has been used in infants with bronchiolitis for decades. Recently, high flow nasal cannula (HFNC) therapy was introduced. We conducted a trial of 50 children with bronchiolitis who were randomized to treatment with CPAP or HFNC. Objectives were to compare the development in respiratory rate, pCO2, and Modified Woods Clinical Asthma Score (M-WCAS) in young children with bronchiolitis, treated with CPAP or HFNC. Secondarily, to compare Neonatal Infant Pain Score (NIPS), treatment duration, treatment failure, and hospitalization length. Median age at inclusion was 2.8 (CPAP group) vs 2.1 months (HFNC group). Mean baseline pCO2 was 6.7 in both groups and mean respiratory rate was 60 vs 56 in the CPAP and HFNC group respectively. No differences were observed in development of respiratory rate, pCO2, or M-WCAS. NIPS was higher in the CPAP group. Treatment failure was scarce in both groups. No significant differences in treatment duration or length of hospitalization were observed.Conclusion: In infants and young children with bronchiolitis, HFNC may be an effective and pleasant alternative to CPAP. Larger multicenter studies are needed to further explore differences in treatment failure and treatment duration.Trial registration: www.clinicaltrial.gov. id NCT02618213, registration date December 1, 2015.What is Known:• CPAP has been used for many years for respiratory support in infant bronchiolitis. The method requires special staff skills and may be stressful to the child.• HFNC has been introduced as a newer tool.What is New:• In infants with bronchiolitis, HFNC and CPAP were comparable in decreasing respiratory rate, pCO2, and need for oxygen supply.• Pain score during therapy was lower in the HFNC group.
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Affiliation(s)
- Signe Vahlkvist
- Department of Pediatric and Adolecent Medicine, Hospital South West Jutland, Finsensgade 35, Esbjerg, 6700, Denmark. .,Department of Paediatrics and Adolescent Medicine, Hospital of Lillebaelt, Sygehusvej 24, Kolding, 6000, Denmark.
| | - Louise Jürgensen
- Department of Paediatrics and Adolescent Medicine, Hospital of Lillebaelt, Sygehusvej 24, Kolding, 6000, Denmark
| | - Amalie la Cour
- Department of Pediatric and Adolecent Medicine, Hospital South West Jutland, Finsensgade 35, Esbjerg, 6700, Denmark
| | - Simone Markoew
- Department of Pediatric and Adolecent Medicine, Hospital South West Jutland, Finsensgade 35, Esbjerg, 6700, Denmark
| | - Thomas Houmann Petersen
- Department of Paediatrics and Adolescent Medicine, Hospital of Lillebaelt, Sygehusvej 24, Kolding, 6000, Denmark
| | - Poul-Erik Kofoed
- Department of Paediatrics and Adolescent Medicine, Hospital of Lillebaelt, Sygehusvej 24, Kolding, 6000, Denmark
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The Role of Viral Coinfection in Bronchiolitis Treated With High-Flow Nasal Cannula at Pediatric Emergency Department During 2 Consecutive Seasons: An Observational Study. Pediatr Infect Dis J 2020; 39:102-107. [PMID: 31725117 DOI: 10.1097/inf.0000000000002512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND The role of multiple respiratory viruses in bronchiolitis treated with high-flow nasal cannula (HFNC) has not been thoroughly investigated. We evaluated the contribution of coinfection on clinical course of bronchiolitis treated with HFNC and on response to this treatment. METHODS We selected 120 children with bronchiolitis, younger than 12 months, admitted to Emergency Department between 2016 and 2018 and treated with HFNC. We compared single and multiple virus infections in relation to specific outcomes such as the clinical response to HFNC and the HFNC failure. The multiple virus infection was defined by the detection of 2 or more viruses in nasopharyngeal aspirates. The HFNC failure was defined as escalation to higher level of care, including Helmet-Continuous Positive Airway Pressure, invasive ventilation or transfer to pediatric intensive care unit within 48 hours from the time of HFNC initiation. We also performed a comparison between HFNC failure and HFNC not-failure groups according to the number of virus and the type of virus. RESULTS The severity score post-HFNC initiation was significantly associated with coinfection [odds ratio (OR): 1.361; 95% confidence interval (CI): 1.036-1.786; P = 0.027]. The likelihood of coinfection decreased by 23.1% for each increase of saturation O2 after HFNC initiation (OR: 0.769; 95% CI: 0.609-0.972; P = 0.028). Atelectasis was more likely to occur in coinfection (OR: 2.923; 95% CI: 1.049-8.148; P = 0.04). The duration of HFNC treatment increased significantly in coinfection (OR: 1.018; 95% CI: 1.006-1.029; P = 0.002). No significant differences were described between HFNC failure and the number and the type of detected viruses. CONCLUSIONS The detection of multiple viruses and the type of virus did not influence the HFNC failure, although the coinfection was associated with a deterioration of severity score, a longer HFNC treatment and a major presence of atelectasis. The role of coinfection on HFNC treatment might subtend a complex interplay between multiple viruses and host susceptibility.
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31
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Song KB, Kil HR, Cho EY, Lee MH, Chung EH. Effect of high flow nasal cannula treatment in children with respiratory distress at the general ward. ALLERGY ASTHMA & RESPIRATORY DISEASE 2020. [DOI: 10.4168/aard.2020.8.2.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Kun Baek Song
- Department of Pediatrics, Chungnam National University School of Medicine, Daejeon, Korea
| | - Hong Ryang Kil
- Department of Pediatrics, Chungnam National University School of Medicine, Daejeon, Korea
| | - Eun Young Cho
- Department of Pediatrics, Chungnam National University School of Medicine, Daejeon, Korea
| | - Mi-Hee Lee
- Department of Pediatrics, Incheon Medical Center, Incheon, Korea
| | - Eun Hee Chung
- Department of Pediatrics, Chungnam National University School of Medicine, Daejeon, Korea
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32
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PICU Admission Rates in Pediatric Cancer and Hematopoietic Stem Cell Transplant Patients Receiving High-flow Nasal Cannula Oxygen Therapy on the General Ward. J Pediatr Hematol Oncol 2020; 42:e1-e6. [PMID: 31688639 DOI: 10.1097/mph.0000000000001649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The use of high-flow nasal cannula (HFNC) oxygen therapy is growing as an alternative to standard oxygen. However, its use in patients treated for malignancies, including hematopoietic stem cell transplantation (HSCT) patients, is controversial. In this retrospective cohort study, we assessed outcomes of pediatric cancer and HSCT patients (including nonmalignant indications) with acute hypoxemic respiratory failure treated with HFNC on the ward. Among 39 patients included in the study, 53 episodes of HFNC treatment were analyzed. Of these episodes, 18 (34%) failed and patients required subsequently pediatric intensive care unit (PICU) admission. A significant median higher C reactive protein (175 [range, 72 to 308] vs. 80 [13.5 to 187.8] mg/dL; P=0.006) and higher Bedside Pediatric Early Warning Score (PEWS) 1 to 4 hours after initiation of HFNC (10.1±0.8 vs. 7.1±0.4; P=0.001) was found in the failure group compared with the nonfailure group. Among the 18 patients admitted to PICU, 14 (78%) needed intubation. Five (28%) patients died during their PICU admission. In summary, one third of the pediatric cancer and HSCT patients receiving HFNC on the ward eventually required PICU admission of which 78% were intubated. C reactive protein and BedsidePEWS 1 to 4 hours after initiation of HFNC were significantly associated with the need for PICU admission. However, no firm conclusion can be drawn whether HFNC treatment should actually be initiated in the ward in this vulnerable patient population. Larger, prospective studies are needed to evaluate the most appropriate treatment and setting (PICU or general ward) for these patients.
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33
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Franklin D, Shellshear D, Babl FE, Schlapbach LJ, Oakley E, Borland ML, Hoeppner T, George S, Craig S, Neutze J, Williams A, Acworth J, McCay H, Wallace A, Mattes J, Gangathimn V, Wildman M, Fraser JF, Moloney S, Gavranich J, Waugh J, Hobbins S, Fahy R, Grew S, Gannon B, Gibbons K, Dalziel S, Schibler A. Multicentre, randomised trial to investigate early nasal high-flow therapy in paediatric acute hypoxaemic respiratory failure: a protocol for a randomised controlled trial-a Paediatric Acute respiratory Intervention Study (PARIS 2). BMJ Open 2019; 9:e030516. [PMID: 31857300 PMCID: PMC6937038 DOI: 10.1136/bmjopen-2019-030516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Acute hypoxaemic respiratory failure (AHRF) in children is the most frequent reason for non-elective hospital admission. During the initial phase, AHRF is a clinical syndrome defined for the purpose of this study by an oxygen requirement and caused by pneumonia, lower respiratory tract infections, asthma or bronchiolitis. Up to 20% of these children with AHRF can rapidly deteriorate requiring non-invasive or invasive ventilation. Nasal high-flow (NHF) therapy has been used by clinicians for oxygen therapy outside intensive care settings to prevent escalation of care. A recent randomised trial in infants with bronchiolitis has shown that NHF therapy reduces the need to escalate therapy. No similar data is available in the older children presenting with AHRF. In this study we aim to investigate in children aged 1 to 4 years presenting with AHRF if early NHF therapy compared with standard-oxygen therapy reduces hospital length of stay and if this is cost-effective compared with standard treatment. METHODS AND ANALYSIS The study design is an open-labelled randomised multicentre trial comparing early NHF and standard-oxygen therapy and will be stratified by sites and into obstructive and non-obstructive groups. Children aged 1 to 4 years (n=1512) presenting with AHRF to one of the participating emergency departments will be randomly allocated to NHF or standard-oxygen therapy once the eligibility criteria have been met (oxygen requirement with transcutaneous saturation <92%/90% (dependant on hospital standard threshold), diagnosis of AHRF, admission to hospital and tachypnoea ≥35 breaths/min). Children in the standard-oxygen group can receive rescue NHF therapy if escalation is required. The primary outcome is hospital length of stay. Secondary outcomes will include length of oxygen therapy, proportion of intensive care admissions, healthcare resource utilisation and associated costs. Analyses will be conducted on an intention-to-treat basis. ETHICS AND DISSEMINATION Ethics approval has been obtained in Australia (HREC/15/QRCH/159) and New Zealand (HDEC 17/NTA/135). The trial commenced recruitment in December 2017. The study findings will be submitted for publication in a peer-reviewed journal and presented at relevant conferences. Authorship of all publications will be decided by mutual consensus of the research team. TRIAL REGISTRATION NUMBER ACTRN12618000210279.
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Affiliation(s)
- Donna Franklin
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- School of Medicine, The University Of Queensland, St Lucia, Queensland, Australia
- Mater Medical Research Institute, South Brisbane, Queensland, Australia
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
| | - Deborah Shellshear
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- Emergency Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Franz E Babl
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- Emergency Department, Royal Childrens Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Services, University of Melbourne, Melbourne, Victoria, Australia
| | - Luregn J Schlapbach
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- School of Medicine, The University Of Queensland, St Lucia, Queensland, Australia
- Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Ed Oakley
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- Emergency Department, Royal Childrens Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Services, University of Melbourne, Melbourne, Victoria, Australia
| | - Meredith L Borland
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- Emergency, Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia
- University of Western Australia, School of Medicine, Divisions of Emergency Medicine and Paediatrics, Crawley, Western Australia, Australia
| | - Tobias Hoeppner
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- Emergency, Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia
| | - Shane George
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- School of Medicine, The University Of Queensland, St Lucia, Queensland, Australia
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- Emergency Department, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Simon Craig
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- Emergency Department, Monash Medical Centre Clayton, Clayton, Victoria, Australia
- Department of Medicine, School of Clinical Science, Monash University, Clayton, Victoria, Australia
| | - Jocelyn Neutze
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- KidzFirst Middlemore Emergency Department, Middlemore Hospital, Auckland, New Zealand
- University of Auckland, Auckland, New Zealand
| | - Amanda Williams
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- Emergency Department, Royal Childrens Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Jason Acworth
- School of Medicine, The University Of Queensland, St Lucia, Queensland, Australia
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- Emergency Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Hamish McCay
- Paediatrics, Waikato Hospital, Hamilton, New Zealand
| | - Alex Wallace
- Paediatrics, Waikato Hospital, Hamilton, New Zealand
| | - Joerg Mattes
- Paediatrics, John Hunter Children's Hospital, Hunter Region Mail Centre, New South Wales, Australia
- University of Newcastle, Priority Research Centre GrowUpWell, Callaghan, New South Wales, Australia
| | - Vinay Gangathimn
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- Emergency Department, Townsville General Hospital, Townsville, Queensland, Australia
| | - Mark Wildman
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- Emergency Department, Townsville General Hospital, Townsville, Queensland, Australia
| | - John F Fraser
- Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Queensland, Australia
| | - Susan Moloney
- Paediatric Department, Gold Coast University Hospital, Southport, Queensland, Australia
| | - John Gavranich
- Paediatrics, Ipswich Hospital, Ipswich, Queensland, Australia
| | - John Waugh
- Paediatrics, Caboolture Hospital, Caboolture, Queensland, Australia
| | - Sue Hobbins
- Paediatrics, Prince Charles Hospital, Chermside, Queensland, Australia
| | - Rose Fahy
- Paediatrics, Prince Charles Hospital, Chermside, Queensland, Australia
| | - Simon Grew
- Paediatrics, Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Brenda Gannon
- The University of Queensland, Centre for Business and Economics of Health, St Lucia Qld, Queensland, Australia
| | - Kristen Gibbons
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Mater Medical Research Institute, South Brisbane, Queensland, Australia
| | - Stuart Dalziel
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- University of Auckland, Auckland, New Zealand
- Starship Children's Health, Emergency Department, Newmarket, New Zealand
- Department of Surgery and Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Andreas Schibler
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- School of Medicine, The University Of Queensland, St Lucia, Queensland, Australia
- Mater Medical Research Institute, South Brisbane, Queensland, Australia
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- Queensland Children's Hospital, South Brisbane, Queensland, Australia
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Sachs N, Rom E, Schonfeld T, Gavish R, Berger I, Krause I. Short-Term High-Flow Nasal Cannula for Moderate to Severe Bronchiolitis Is Effective in a General Pediatric Ward. Clin Pediatr (Phila) 2019; 58:1522-1527. [PMID: 31556700 DOI: 10.1177/0009922819877881] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We examined the clinical and physiological benefits of heated humidified high-flow nasal cannula (HHHFNC) in treating pediatric bronchiolitis in a general pediatric ward. Children aged 0 to 2 years, hospitalized with moderate to severe bronchiolitis, were connected to HHHFNC. Each child was evaluated at 4- to 10-hour intervals, both on and off the device, using the Wang et al Bronchiolitis Severity score and transcutaneous CO2 monitor. Sixteen children were included in the final analysis. The Bronchiolitis Severity score improved by 3 points during the first and second intervals (P = .001). Transcutaneous CO2 values were reduced by an average 8.7 mm Hg (P = .001). No adverse effects were noted in children connected to the device. The HHHFNC device used in a general pediatric ward setting served as a safe and efficacious tool in treating moderate to severe bronchiolitis. Immediate clinical and physiological improvement was observed and maintained 1 to 4 hours after disconnection from the device.
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Affiliation(s)
- Nimrod Sachs
- Schneider Children's Medical Center, Petah Tikva, Israel.,Tel-Aviv University, Tel Aviv, Israel
| | - Eran Rom
- Schneider Children's Medical Center, Petah Tikva, Israel.,Tel-Aviv University, Tel Aviv, Israel
| | | | - Rachel Gavish
- Schneider Children's Medical Center, Petah Tikva, Israel.,Tel-Aviv University, Tel Aviv, Israel
| | - Itay Berger
- Schneider Children's Medical Center, Petah Tikva, Israel
| | - Irit Krause
- Schneider Children's Medical Center, Petah Tikva, Israel.,Tel-Aviv University, Tel Aviv, Israel
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Daverio M, Da Dalt L, Panozzo M, Frigo AC, Bressan S. A two-tiered high-flow nasal cannula approach to bronchiolitis was associated with low admission rate to intensive care and no adverse outcomes. Acta Paediatr 2019; 108:2056-2062. [PMID: 31102551 DOI: 10.1111/apa.14869] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 05/14/2019] [Accepted: 05/16/2019] [Indexed: 11/29/2022]
Abstract
AIM We aimed to describe the characteristics and outcomes of infants with bronchiolitis who received high-flow nasal cannula oxygen (HFNC) following a two-tiered approach. METHODS This retrospective study included 211 infants below 12 months of age needing oxygen therapy for bronchiolitis, between 2012 and 2017, on the general paediatric ward of the tertiary Paediatric Hospital of Padova, Italy. HFNC was used as first-line therapy for moderate to severe disease and as rescue therapy for deterioration on low-flow oxygen. RESULTS Median age was 61 days (IQR 31-126), and 57.3% were males. HFNC was used as first-line therapy in 35/211 (16.6%) infants and as rescue in 73/176 (41.5%) patients on low-flow oxygen. Overall 9/211 patients (4.3%) were admitted to intensive care, representing a HFNC failure of 9/108 (8.3%). Intensive care admissions did not significantly differ between initial low-flow oxygen therapy and HFNC (8/176, 4.5% versus 1/35, 2.8%, proportion difference 1.7%, 95%CI -10.2 to 6.7), or between initial and rescue HFNC (1/35, 2.8% versus 8/73, 10.9%; proportion difference 8.1%, 95%CI -4.5 to 18). Only two patients developed air leak and were treated conservatively. CONCLUSION A two-tiered approach to HFNC use in bronchiolitis was associated with low intensive care admissions and no adverse outcomes.
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Affiliation(s)
- Marco Daverio
- Paediatric Intensive Care Unit Department of Women's and Children's Health University Hospital of Padova Padova Italy
| | - Liviana Da Dalt
- Paediatric Emergency Unit Department of Women's and Children's Health University Hospital of Padova Padova Italy
| | - Matteo Panozzo
- Paediatric Emergency Unit Department of Women's and Children's Health University Hospital of Padova Padova Italy
| | - Anna Chiara Frigo
- Biostatistics, Epidemiology and Public Health Unit Department of Cardiac Thoracic and Vascular Sciences University of Padova Padova Italy
| | - Silvia Bressan
- Paediatric Emergency Unit Department of Women's and Children's Health University Hospital of Padova Padova Italy
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36
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Panciatici M, Fabre C, Tardieu S, Sauvaget E, Dequin M, Stremler-Le Bel N, Bosdure E, Dubus JC. Use of high-flow nasal cannula in infants with viral bronchiolitis outside pediatric intensive care units. Eur J Pediatr 2019; 178:1479-1484. [PMID: 31372745 DOI: 10.1007/s00431-019-03434-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/30/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Abstract
High-flow nasal cannula (HFNC) is frequently used in infants with acute viral bronchiolitis outside pediatric intensive care units (PICU). A structured questionnaire was sent out to pediatricians of all public French hospitals with pediatric emergency and/or general pediatric departments on their use of HFNC outside PICU (department using HFNC, number of available devices, monitoring, criteria for initiating or stopping HFNC, and personal comments on HFNC). Of the 166 eligible hospitals, 135 answered (96 general and 39 university hospitals; 81.3%), for a total of 217 answering pediatricians. Seventy-two hospitals (53.3%) used HFNC in acute bronchiolitis outside PICU, particularly, general hospitals (59.4% vs 38.5%), and mostly in pediatric general departments (75%). Continuous patient monitoring with a cardiorespiratory monitor was usual (n = 58, 80%). Nursing staff was responsible for 2.7 children on HFNC and checked vital signs 8.6 times per day. Criteria for HFNC initiation and withdrawal were not standardized. Pediatricians had a positive opinion of HFNC and were willing to extend its use to other diseases.Conclusion: Use of HFNC outside PICU in infants with acute bronchiolitis is now usual, but urgently requires guidelines. What is Known: • Acute viral bronchiolitis treatment is only supportive • High-flow nasal cannula (HFNC) is a respiratory support accumulating convincing clinical evidence in bronchiolitis • This latter treatment is usually proposed in pediatric intensive care unit (PICU) What is New: • HFNC are increasingly used outside PICU in bronchiolitis, particularly, in general hospitals and in pediatric general departments • Pediatricians are enthusiastic about this device, but validated criteria for initiation and withdrawal are lacking • Guidelines for the use of HFNC outside PICU are urgently required.
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Affiliation(s)
- Mélanie Panciatici
- Service de Médecine Infantile et Pneumologie pédiatrique, CHU Timone-Enfants, 264 rue Saint-Pierre, 13385, Marseille Cedex 5, France.
| | - Candice Fabre
- Service de Médecine Infantile et Pneumologie pédiatrique, CHU Timone-Enfants, 264 rue Saint-Pierre, 13385, Marseille Cedex 5, France
| | - Sophie Tardieu
- Service d'Evaluation médicale, Pôle de Santé publique, Hôpital de la Conception, Marseille, France
| | - Emilie Sauvaget
- Service de pédiatrie, Hôpital Saint-Joseph, Marseille, France
| | - Marion Dequin
- Service de Médecine Infantile et Pneumologie pédiatrique, CHU Timone-Enfants, 264 rue Saint-Pierre, 13385, Marseille Cedex 5, France
| | - Nathalie Stremler-Le Bel
- Service de Médecine Infantile et Pneumologie pédiatrique, CHU Timone-Enfants, 264 rue Saint-Pierre, 13385, Marseille Cedex 5, France
| | - Emmanuelle Bosdure
- Service de Médecine Infantile et Pneumologie pédiatrique, CHU Timone-Enfants, 264 rue Saint-Pierre, 13385, Marseille Cedex 5, France
| | - Jean-Christophe Dubus
- Service de Médecine Infantile et Pneumologie pédiatrique, CHU Timone-Enfants, 264 rue Saint-Pierre, 13385, Marseille Cedex 5, France.,IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, Aix Marseille Université, Marseille, France
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Perez–Zabalza M, Hagmeijer R, Thio BJ, Bors J, Hoppenbrouwer X, Garde A. Analysis of heart rate variability in children during high flow nasal cannula therapy. Biomed Phys Eng Express 2019. [DOI: 10.1088/2057-1976/ab2d11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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38
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O'Brien S, Craig S, Babl FE, Borland ML, Oakley E, Dalziel SR. 'Rational use of high-flow therapy in infants with bronchiolitis. What do the latest trials tell us?' A Paediatric Research in Emergency Departments International Collaborative perspective. J Paediatr Child Health 2019; 55:746-752. [PMID: 31270867 DOI: 10.1111/jpc.14496] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 01/29/2019] [Accepted: 04/30/2019] [Indexed: 11/26/2022]
Abstract
Bronchiolitis is the most common reason for infants to be hospitalised. Over the past decade, the use of high-flow nasal cannulae (HFNC) therapy has increased markedly and it is now utilised not only in the intensive care unit setting but in general paediatric wards and emergency departments. The aim of this systematic review was to summarise and critique the current evidence-base for the use of HFNC in infants with bronchiolitis. We searched Ovid Medline, OvidEmbase, PubMed, Cinahl, Cochrane Library, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials for systematic reviews and randomised controlled trials of HFNC therapy in infants with bronchiolitis from 1 January 2000 to 27 June 2018. We identified four randomised controlled trials (n = 1891) of HFNC in infants with bronchiolitis: three of these studies involved infants treated in emergency departments and inpatient paediatric wards in Spain, Australia and New Zealand, and one study involved infants treated in paediatric intensive care units in France. The findings of this review suggest that HFNC should be used as a rescue treatment for hypoxaemic infants who have not responded to standard sub nasal oxygen therapy. The use of HFNC for work of breathing in the absence of hypoxaemia, and severe disease, is not currently supported by the evidence, and should only be considered in the context of an appropriate research trial.
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Affiliation(s)
- Sharon O'Brien
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.,School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Simon Craig
- Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia.,School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Franz E Babl
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Emergency Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.,Division of Paediatric and Emergency Medicine, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Ed Oakley
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Emergency Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Paediatric Emergency Medicine Centre of Research Excellence, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Stuart R Dalziel
- Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand.,Department of Surgery, Child and Youth Health, The University of Auckland, Auckland, New Zealand.,Department of Paediatrics, Child and Youth Health, The University of Auckland, Auckland, New Zealand
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Franklin D, Fraser JF, Schibler A. Respiratory support for infants with bronchiolitis, a narrative review of the literature. Paediatr Respir Rev 2019; 30:16-24. [PMID: 31076380 DOI: 10.1016/j.prrv.2018.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/04/2018] [Indexed: 11/19/2022]
Abstract
Bronchiolitis is a common viral disease that significantly affects infants less than 12 months of age. The purpose of this review is to present a review of the current knowledge of the uses of respiratory support in the management of infants with bronchiolitis presenting to hospital. We electronically searched MEDLINE, Cochrane, CINAHL and EMBASE (inception to 25th March 2018), to manually search for clinical trials that address the management strategies for respiratory support of infants with bronchiolitis. We identified 120 papers who met the inclusion criteria, of which 33 papers were relevant for this review with only nine randomized controlled trials. This review demonstrated that non-invasive respiratory support reduced the need for escalation of therapy, particularly the proportion of intubations required for infants with bronchiolitis. Additionally, clear economic benefits have been demonstrated when non-invasive ventilation has been used. The potential early use of non-invasive respiratory supports such as nasal high flow therapy and non-invasive ventilation may have an impact on health care costs and reduction in ICU admissions and intubation rates. High-grade evidence demonstrates safety and quality of high flow therapy in general ward settings.
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Affiliation(s)
- Donna Franklin
- Paediatric Critical Care Research Group, Lady Cilento Children's Hospital, Australia; Mater Research Institute, The University of Queensland, Brisbane, Australia; The University of Queensland, School of Medicine, Brisbane, Australia; Critical Care Research Group, Adult Intensive Care Service, The Prince Charles Hospital, Brisbane, Australia.
| | - John F Fraser
- The University of Queensland, School of Medicine, Brisbane, Australia; Critical Care Research Group, Adult Intensive Care Service, The Prince Charles Hospital, Brisbane, Australia
| | - Andreas Schibler
- Paediatric Critical Care Research Group, Lady Cilento Children's Hospital, Australia; Mater Research Institute, The University of Queensland, Brisbane, Australia; The University of Queensland, School of Medicine, Brisbane, Australia
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Hodgson KA, Davis PG, Owen LS. Nasal high flow therapy for neonates: Current evidence and future directions. J Paediatr Child Health 2019; 55:285-290. [PMID: 30614098 DOI: 10.1111/jpc.14374] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 10/18/2018] [Accepted: 12/16/2018] [Indexed: 11/28/2022]
Abstract
Nasal high flow (nHF) therapy is a commonly used method of providing non-invasive respiratory support for neonates. It has several potential mechanisms of action: continuous distending pressure, nasopharyngeal dead space washout, provision of heated and humidified gases and reduction of work of breathing. nHF is used in a number of clinical scenarios for preterm and term infants, including primary respiratory and post-extubation support. In recent years, large trials have generated evidence pertinent to these indications. Novel applications for nHF in neonates warrant further research: during endotracheal intubation, for initial delivery room stabilisation of preterm infants and in conjunction with minimally invasive surfactant therapy.
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Affiliation(s)
- Kate A Hodgson
- Newborn Research Centre, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Peter G Davis
- Newborn Research Centre, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Louise S Owen
- Newborn Research Centre, Royal Women's Hospital, Melbourne, Victoria, Australia
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De Santis D, Sheriff F, Bester D, Shahab R, Hutzal C. Uses of high-flow nasal cannula on the community paediatric ward and risk factors for deterioration. Paediatr Child Health 2019; 25:102-106. [PMID: 33390747 DOI: 10.1093/pch/pxy123] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/17/2018] [Accepted: 06/18/2018] [Indexed: 01/22/2023] Open
Abstract
Background High-flow nasal cannula (HFNC) is a form of noninvasive respiratory support used for paediatric acute respiratory illnesses. Past HFNC research has focused on its use in bronchiolitis and in intensive care units, but little is reported on its use in the community hospital setting. We aimed to investigate the paediatric population using HFNC, any adverse events, and risk factors for deterioration. Methods A retrospective chart review was performed on patients admitted to a community paediatric ward. Inclusion criteria were patients between 1 day and 17 years of age, admitted between September 2013 and April 2016, and treated with HFNC for at least 4 hours. Results A total of 85 children met inclusion criteria. The average age of patients in our study was 3.41 years with 39% of patients >2 years of age. 46% of patients had an admitting diagnosis of bronchiolitis, 33% pneumonia, and 16% with asthma. Transfer rate to tertiary care centre paediatric intensive care unit was 18%. Patients transferred required greater FIO2 (odds ratio [OR] 1.04, P=0.018, confidence interval [CI] 1.007 to 1.082), and were 3.2 times more likely to be positive for respiratory syncytial virus (RSV) (P=0.081, CI 0.868-11.739). There were no adverse events attributed to HFNC in the population. Conclusion HFNC is being utilized in the community hospital setting for children of varied age and types of respiratory illnesses. Children requiring higher FIO2 are at risk of respiratory deterioration which may identify them earlier for transfer to tertiary care. Further research into the safety and efficacy of HFNC for different paediatric illnesses in the community is needed.
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Affiliation(s)
- Diana De Santis
- Michael G. DeGroote School of Medicine, McMaster University, Waterloo Regional Campus, Kitchener, Ontario
| | - Falana Sheriff
- Michael G. DeGroote School of Medicine, McMaster University, Waterloo Regional Campus, Kitchener, Ontario
| | - Deborah Bester
- Respiratory Therapy, Grand River Hospital, Kitchener, Ontario
| | - Rabia Shahab
- Data Integration and Reporting Specialist Department, Grand River Hospital, Kitchener, Ontario
| | - Carolyn Hutzal
- Department of Pediatrics, Grand River Hospital, Kitchener, Ontario
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Kerris EJ, Patregnani JT, Sharron M, Sochet AA. Use of the pediatric intensive care unit for post-procedural monitoring in young children following microlaryngobronchoscopy: Impact on resource utilization and hospital cost. Int J Pediatr Otorhinolaryngol 2018; 115:1-5. [PMID: 30368366 DOI: 10.1016/j.ijporl.2018.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 09/01/2018] [Accepted: 09/12/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the frequency of post-procedural complications, medical interventions, and hospital costs associated with microlaryngobronchoscopy (MLB) in children prophylactically admitted for pediatric intensive care unit (PICU) monitoring for age ≤ 2 years. METHODS We performed a single-center, retrospective, descriptive study within a 44-bed PICU in a stand-alone, tertiary, pediatric referral center. Inclusion criteria were age ≤2 years and pre-procedural selection of prophylactic PICU monitoring after MLB between January 2010 and December 2015. Children were excluded for existing tracheostomy, if undergoing concurrent non-otolaryngeal procedures, or if intubated at the time of PICU admission. Primary outcomes were the development of major and minor procedural complications and medical rescue interventions. Secondary outcomes were hospital cost and length of stay (LOS). RESULTS One hundred and eight subjects met inclusion criteria with a median age of 5.3 (IQR: 2.6-10.9) months. A majority (86%) underwent therapeutic instrumentation in addition to diagnostic MLB. There were no observed major complications or rescue interventions. Minor complications were noted within 5 h of monitoring and included isolated stridor (24%), desaturation <90% (10%), and nausea/emesis (8%). Minor interventions included supplemental oxygen via regular nasal cannula (39%), single-dose inhaled racemic epinephrine (19%), single-dose systemic corticosteroids (19%), or high flow nasal cannula (HFNC) therapy (4%). Save for two cases of HFNC, interventions were completed or discontinued within 5 h. Median PICU LOS was 1.1 days and median cost was $9650 (IQR: $8235- $14,861) per encounter. Estimated cost of same day observation in our post anesthesia care unit (PACU) following MLB without PICU admission is $1921 per encounter. CONCLUSIONS In children ≤ 2 years of age prophylactically admitted for PICU observation, we did not observe severe complications or major interventions after MLB. Minor interventions and complications were noted early during post-procedural monitoring. PICU monitoring was substantially more expensive than same-day PACU observation. Young age as the sole criteria for prophylactic PICU monitoring after diagnostic or therapeutic MLB may be unjustified when comparable, cost-conscious care can be achieved in a PACU setting. Prior to pre-procedural selection of PICU monitoring, we recommend a broad contextual risk assessment including a review of comorbidities, operative plan, and intended anesthetic exposure.
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Affiliation(s)
- Elizabeth J Kerris
- Pediatric Critical Care Medicine, Department of Medicine, Division of Critical Care Medicine, Children's National Health System, 111 Michigan Ave NW, Suite M4811, Washington, DC, 20010, USA.
| | - Jason T Patregnani
- Pediatric Cardiac Intensive Care Medicine, Department of Medicine Division of Cardiac Intensive Care Medicine, Children's National Health System, 111 Michigan Ave NW, Suite M4811, Washington, DC, 20010, USA.
| | - Matthew Sharron
- Pediatric Critical Care Medicine, Department of Medicine, Division of Critical Care Medicine, Children's National Health System, 111 Michigan Ave NW, Suite M4811, Washington, DC, 20010, USA.
| | - Anthony A Sochet
- Anesthesiology and Critical Care Medicine, Department of Medicine, Division of Pediatric Critical Care Medicine, Johns Hopkins All Children's Hospital, Johns Hopkins University, 501 6th Street South, OCC Suite 702, Room 709, St. Petersburg, FL, 33701, USA.
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Heikkilä P, Sokuri P, Mecklin M, Nuolivirta K, Tapiainen T, Peltoniemi O, Renko M, Korppi M. Using high-flow nasal cannulas for infants with bronchiolitis admitted to paediatric wards is safe and feasible. Acta Paediatr 2018; 107:1971-1976. [PMID: 29802651 DOI: 10.1111/apa.14421] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/08/2018] [Accepted: 05/23/2018] [Indexed: 12/17/2022]
Abstract
AIM Using a high-flow nasal cannula (HFNC) for infant bronchiolitis is increasingly common, but insufficiently studied. In this retrospective study, we examined the outcomes of HFNC and compared infants who did and did not respond to this oxygen delivery method. METHODS This 2012-2015 study of six Finnish hospitals focused on 88 infants under 12 months who received HFNC: 53 on paediatric wards and 35 in paediatric intensive care units (PICUs). We reviewed patient files for underlying factors, clinical parameters and HFNC treatment. The treatment failed if the patient was transferred to another respiratory support. RESULTS We found HFNC treatment was successful in 76 (86%) infants, including all 53 on the paediatric wards and 23/35 PICU patients. The responders' heart rates were significantly lower, and their oxygen saturation was significantly higher at 60 minutes after HFNC treatment started and then stayed relatively constant. Their respiratory rate was only significantly lower after 360 minutes. In non-responders, the respiratory rate initially decreased but was higher at 180 and 360 minutes after the start of HFNC. CONCLUSION We found preliminary evidence that oxygen support needs and heart rate were useful early predictors of HFNC therapy success in infants hospitalised with bronchiolitis, but respiratory rate was not.
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Affiliation(s)
- Paula Heikkilä
- Centre for Child Health Research; Tampere University and University Hospital; Tampere Finland
| | - Paula Sokuri
- Centre for Child Health Research; Tampere University and University Hospital; Tampere Finland
| | - Minna Mecklin
- Centre for Child Health Research; Tampere University and University Hospital; Tampere Finland
| | - Kirsi Nuolivirta
- Department of Paediatrics; Seinäjoki Central Hospital; Seinäjoki Finland
| | - Terhi Tapiainen
- Department of Paediatrics; PEDEGO Research Centre; Oulu University Hospital; Oulu University; Oulu Finland
| | - Outi Peltoniemi
- Department of Paediatrics; PEDEGO Research Centre; Oulu University Hospital; Oulu University; Oulu Finland
| | - Marjo Renko
- Centre for Child Health Research; Tampere University and University Hospital; Tampere Finland
- Department of Paediatrics; PEDEGO Research Centre; Oulu University Hospital; Oulu University; Oulu Finland
| | - Matti Korppi
- Centre for Child Health Research; Tampere University and University Hospital; Tampere Finland
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A multicenter randomized controlled trial of a 3-L/kg/min versus 2-L/kg/min high-flow nasal cannula flow rate in young infants with severe viral bronchiolitis (TRAMONTANE 2). Intensive Care Med 2018; 44:1870-1878. [DOI: 10.1007/s00134-018-5343-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 08/03/2018] [Indexed: 01/01/2023]
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Freire G, Kuppermann N, Zemek R, Plint AC, Babl FE, Dalziel SR, Freedman SB, Atenafu EG, Stephens D, Steele DW, Fernandes RM, Florin TA, Kharbanda A, Lyttle MD, Johnson DW, Schnadower D, Macias CG, Benito J, Schuh S. Predicting Escalated Care in Infants With Bronchiolitis. Pediatrics 2018; 142:peds.2017-4253. [PMID: 30126934 DOI: 10.1542/peds.2017-4253] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Early risk stratification of infants with bronchiolitis receiving airway support is critical for focusing appropriate therapies, yet the tools to risk categorize this subpopulation do not exist. Our objective was to identify predictors of "escalated care" in bronchiolitis. We hypothesized there would be a significant association between escalated care and predictors in the emergency department. We subsequently developed a risk score for escalated care. METHODS We conducted a retrospective cohort study of previously healthy infants aged <12 months with bronchiolitis. Our primary outcome was escalated care (ie, hospitalization with high-flow nasal cannula, noninvasive or invasive ventilation, or intensive care admission). The predictors evaluated were age, prematurity, day of illness, poor feeding, dehydration, apnea, nasal flaring and/or grunting, respiratory rate, oxygen saturation, and retractions. RESULTS Of 2722 patients, 261 (9.6%) received escalated care. Multivariable predictors of escalated care were oxygen saturation <90% (odds ratio [OR]: 8.9 [95% confidence interval (CI) 5.1-15.7]), nasal flaring and/or grunting (OR: 3.8 [95% CI 2.6-5.4]), apnea (OR: 3.0 [95% CI 1.9-4.8]), retractions (OR: 3.0 [95% CI 1.6-5.7]), age ≤2 months (OR: 2.1 [95% CI 1.5-3.0]), dehydration (OR 2.1 [95% CI 1.4-3.3]), and poor feeding (OR: 1.9 [95% CI 1.3-2.7]). One of 217 (0.5%) infants without predictors received escalated care. The risk score ranged from 0 to 14 points, with the estimated risk of escalated care from 0.46% (0 points) to 96.9% (14 points). The area under the curve was 85%. CONCLUSIONS We identified variables measured in the emergency department predictive of escalated care in bronchiolitis and derived a risk score to stratify risk of this outcome. This score may be used to aid management and disposition decisions.
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Affiliation(s)
| | - Nathan Kuppermann
- Departments of Emergency Medicine and Pediatrics, School of Medicine, University of California, Davis, Sacramento, California
| | - Roger Zemek
- Division of Pediatric Emergency Medicine, University of Ottawa and Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Amy C Plint
- Division of Pediatric Emergency Medicine, University of Ottawa and Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Franz E Babl
- Emergency Department, Royal Children's Hospital, Murdoch Children's Research Institute, Parkville, Australia.,University of Melbourne, Melbourne, Australia
| | - Stuart R Dalziel
- Emergency Department, Starship Children's Hospital and the University of Auckland, Auckland, New Zealand
| | - Stephen B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital, Departments of Pediatrics, Alberta Children's Hospital Research Institute, Cumming School of Medicine, Calgary University, Calgary, Canada
| | - Eshetu G Atenafu
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Derek Stephens
- Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Dale W Steele
- Department of Pediatric Emergency Medicine, Hasbro Children's Hospital and Departments of Emergency Medicine, Pediatrics, and Health Services, Policy, and Practice, Brown University, Providence, Rhode Island
| | - Ricardo M Fernandes
- Department of Pediatrics, Hospital de Santa Maria and Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, Instituto de Medicina Molecular, University of Lisbon, Lisbon, Portugal
| | - Todd A Florin
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Anupam Kharbanda
- Department of Pediatric Emergency Medicine, Children's Hospital of Minnesota, Minneapolis, Minnesota
| | - Mark D Lyttle
- Emergency Department, Bristol Royal Hospital for Children and Faculty of Health and Applied Life Sciences, University of the West of England, Bristol, United Kingdom
| | - David W Johnson
- Sections of Pediatric Emergency Medicine, and Physiology and Pharmacology, Alberta Children's Hospital and Alberta Children's Hospital Research Institute, Cumming School of Medicine, Calgary University, Calgary, Canada
| | - David Schnadower
- Department of Pediatric Emergency Medicine, School of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Charles G Macias
- Department of Pediatric Emergency Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas; and
| | - Javier Benito
- Pediatric Emergency Department, Cruces University Hospital, Barakaldo, Spain
| | - Suzanne Schuh
- Division of Pediatric Emergency Medicine, and .,Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Canada
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Ergul AB, Calıskan E, Samsa H, Gokcek I, Kaya A, Zararsiz GE, Torun YA. Using a high-flow nasal cannula provides superior results to OxyMask delivery in moderate to severe bronchiolitis: a randomized controlled study. Eur J Pediatr 2018; 177:1299-1307. [PMID: 29915869 DOI: 10.1007/s00431-018-3191-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 06/06/2018] [Accepted: 06/07/2018] [Indexed: 11/30/2022]
Abstract
The effectiveness of using a face mask with a small diffuser for oxygen delivery (OxyMask) was compared to use of a high-flow nasal cannula (HFNC) in patients with moderate or severe bronchiolitis.The study population in this open, phase 4, randomized controlled trial consisted of 60 patients aged 1-24 months diagnosed with moderate or severe bronchiolitis and admitted to an intensive care unit (ICU) for oxygen therapy. The patients were randomized into two groups according to the method of oxygen delivery: a diffuser mask group and an HFNC group.There were seven failures in the mask group and none in the HFNC group. The survival probability differed significantly between the two treatment methods (p = 0.009).Time to weaning off oxygen therapy was 56 h in the HFNC group and 96 h in the mask group (p < 0.001).Conclusion: HFNC use decreased the treatment failure rate and the duration of both oxygen therapy and ICU treatment compared to the diffuser mask, which implies that an HFNC should be the first choice for treating patients admitted to the ICU with severe bronchiolitis. What is known: • A high-flow nasal cannula (HFNC) does not significantly reduce the time on oxygen compared to standard therapy in children with moderate to severe bronchiolitis. Observational studies show that, since the introduction of HFNC, fewer children with bronchiolitis need intubation. For children with moderate to severe bronchiolitis there is no proof of its benefit. What Is New: • In children with moderate to severe bronchiolitis, HFNC provides faster and more effective improvement than can be achieved with a diffuser mask.
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Affiliation(s)
- Ayse Betul Ergul
- Department of Pediatric Intensive Care Unit, University of Health Sciences, Kayseri Training and Research Hospital, Ataturk Bulvarı, 38030, Kayseri, Turkey.
| | - Emrah Calıskan
- Department of Pediatrics, University of Health Sciences, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Hasan Samsa
- Department of Pediatric Intensive Care Unit, University of Health Sciences, Kayseri Training and Research Hospital, Ataturk Bulvarı, 38030, Kayseri, Turkey
| | - Ikbal Gokcek
- Department of Pediatric Intensive Care Unit, University of Health Sciences, Kayseri Training and Research Hospital, Ataturk Bulvarı, 38030, Kayseri, Turkey
| | - Ali Kaya
- Department of Pediatric Intensive Care Unit, University of Health Sciences, Kayseri Training and Research Hospital, Ataturk Bulvarı, 38030, Kayseri, Turkey
| | | | - Yasemin Altuner Torun
- Department of Pediatric Hematology, University of Health Sciences, Kayseri Training and Research Hospital, Kayseri, Turkey
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Korppi M. Monitoring of respiratory rate poorly predicts outcome of high-flow oxygen therapy. Pediatr Pulmonol 2018; 53:855-856. [PMID: 29687652 DOI: 10.1002/ppul.24011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 03/22/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Matti Korppi
- Center for Child Health Research, Tampere University and University Hospital, Tampere, Finland
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Er A, Çağlar A, Akgül F, Ulusoy E, Çitlenbik H, Yılmaz D, Duman M. Early predictors of unresponsiveness to high-flow nasal cannula therapy in a pediatric emergency department. Pediatr Pulmonol 2018. [PMID: 29528202 DOI: 10.1002/ppul.23981] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM High-flow nasal cannula (HFNC) is a new treatment option for pediatric respiratory distress and we aimed to assess early predictive factors of unresponsiveness to HFNC therapy in a pediatric emergency department (ED). METHOD Patients who presented with respiratory distress and were treated by HFNC, were included. The age, gender, weight, medical history, diagnosis, vital signs, oxygen saturation/fraction of inspired oxygen (SpO2 /FiO2 ) ratio, modified Respiratory Distress Assessment Instrument (mRDAI) scores, medical interventions, duration of HFNC therapy, time to escalation, adverse effects, and laboratory test results were obtained from medical and nursing records. The requirement of a higher level of respiratory support due to unchanged or increased RR compared to initial RR, incipient, or progressive respiratory acidosis, incipient hemodynamic instability was defined as unresponsiveness to HFNC. RESULTS The study enrolled 154 children with a median age of 10 months (interquartile range [IQR], 5.7-22.5 months). The diagnosis was acute bronchiolitis in 59 patients (38.3%), bacterial pneumonia in 64 patients (41.6%), and atypical or viral pneumonia in 31 patients (20.1%). Twenty-five patients (16.2%) were in the unresponsive group, and the median time for escalating respiratory support was 7 h (IQR: 4-20 h). The unresponsive group had lower SpO2 and SpO2 /FiO2 (SF) ratio on admission, lower venous pH, and higher partial pressure of carbon dioxide (pCO2 ) (P = 0.002, P = 0.012, and P = 0.001, respectively). Also the alteration of RR, mRDAI score, and SF ratio at the first hour was greater in the responsive group. The cut-off value of SF ratio at the first hour of HFNC was 195 for unresponsiveness. CONCLUSION The low initial SpO2 and SF ratio, respiratory acidosis, and SF ratio less than 195 at the first hours of treatment were related to unresponsiveness to HFNC therapy in our pediatric emergency department.
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Affiliation(s)
- Anıl Er
- Division of Pediatric Emergency Medicine, Dokuz Eylul University, School of Medicine, Izmir, Turkey
| | - Aykut Çağlar
- Division of Pediatric Emergency Medicine, Dokuz Eylul University, School of Medicine, Izmir, Turkey
| | - Fatma Akgül
- Division of Pediatric Emergency Medicine, Dokuz Eylul University, School of Medicine, Izmir, Turkey
| | - Emel Ulusoy
- Division of Pediatric Emergency Medicine, Dokuz Eylul University, School of Medicine, Izmir, Turkey
| | - Hale Çitlenbik
- Division of Pediatric Emergency Medicine, Dokuz Eylul University, School of Medicine, Izmir, Turkey
| | - Durgül Yılmaz
- Division of Pediatric Emergency Medicine, Dokuz Eylul University, School of Medicine, Izmir, Turkey
| | - Murat Duman
- Division of Pediatric Emergency Medicine, Dokuz Eylul University, School of Medicine, Izmir, Turkey
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Guillot C, Le Reun C, Behal H, Labreuche J, Recher M, Duhamel A, Leteurtre S. First-line treatment using high-flow nasal cannula for children with severe bronchiolitis: Applicability and risk factors for failure. Arch Pediatr 2018; 25:213-218. [DOI: 10.1016/j.arcped.2018.01.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 12/13/2017] [Accepted: 01/14/2018] [Indexed: 01/07/2023]
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