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Chanci D, Grunwell JR, Rafiei A, Moore R, Bishop NR, Rajapreyar P, Lima LM, Mai M, Kamaleswaran R. Development and Validation of a Model for Endotracheal Intubation and Mechanical Ventilation Prediction in PICU Patients. Pediatr Crit Care Med 2024; 25:212-221. [PMID: 37962125 PMCID: PMC10932861 DOI: 10.1097/pcc.0000000000003410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
OBJECTIVES To develop and externally validate an intubation prediction model for children admitted to a PICU using objective and routinely available data from the electronic medical records (EMRs). DESIGN Retrospective observational cohort study. SETTING Two PICUs within the same healthcare system: an academic, quaternary care center (36 beds) and a community, tertiary care center (56 beds). PATIENTS Children younger than 18 years old admitted to a PICU between 2010 and 2022. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Clinical data was extracted from the EMR. PICU stays with at least one mechanical ventilation event (≥ 24 hr) occurring within a window of 1-7 days after hospital admission were included in the study. Of 13,208 PICU stays in the derivation PICU cohort, 1,175 (8.90%) had an intubation event. In the validation cohort, there were 1,165 of 17,841 stays (6.53%) with an intubation event. We trained a Categorical Boosting (CatBoost) model using vital signs, laboratory tests, demographic data, medications, organ dysfunction scores, and other patient characteristics to predict the need of intubation and mechanical ventilation using a 24-hour window of data within their hospital stay. We compared the CatBoost model to an extreme gradient boost, random forest, and a logistic regression model. The area under the receiving operating characteristic curve for the derivation cohort and the validation cohort was 0.88 (95% CI, 0.88-0.89) and 0.92 (95% CI, 0.91-0.92), respectively. CONCLUSIONS We developed and externally validated an interpretable machine learning prediction model that improves on conventional clinical criteria to predict the need for intubation in children hospitalized in a PICU using information readily available in the EMR. Implementation of our model may help clinicians optimize the timing of endotracheal intubation and better allocate respiratory and nursing staff to care for mechanically ventilated children.
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Affiliation(s)
- Daniela Chanci
- Department of Biomedical Informatics, Emory University, Atlanta, GA
| | - Jocelyn R Grunwell
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Division of Critical Care Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Alireza Rafiei
- Department of Biomedical Informatics, Emory University, Atlanta, GA
| | - Ronald Moore
- Department of Biomedical Informatics, Emory University, Atlanta, GA
| | - Natalie R Bishop
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Division of Critical Care Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Prakadeshwari Rajapreyar
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Division of Critical Care Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Lisa M Lima
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Division of Critical Care Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Mark Mai
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Division of Critical Care Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Rishikesan Kamaleswaran
- Department of Biomedical Informatics, Emory University, Atlanta, GA
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA
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D'Alessandro M, Fricano C, Abdulsatar F, Bechard N, Brar JS, Drouin O, Foulds JL, Giglia L, Gill PJ, Gupta R, Li P, McConnery J, Metcalf J, Sakran M, Seaton C, Sehgal A, Sirizzotti N, Mbuagbaw L, Wahi G. Understanding the use and outcomes of high-flow nasal cannula among infants admitted to Canadian hospitals with bronchiolitis (CanFLO): a protocol for a multicentre, retrospective cohort study. BMJ Open 2024; 14:e080197. [PMID: 38326253 PMCID: PMC10860006 DOI: 10.1136/bmjopen-2023-080197] [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] [Received: 09/23/2023] [Accepted: 01/24/2024] [Indexed: 02/09/2024] Open
Abstract
INTRODUCTION Bronchiolitis is the most common viral lower respiratory tract infection in children under 2 years of age. Respiratory support with high-flow nasal cannula (HFNC) is increasingly used in this patient population with limited understanding of the patients most likely to benefit and considerable practice variability of use. This study aims to understand the factors associated with failure of HFNC support among patients with bronchiolitis and to describe the current practice variations of HFNC use in patients with bronchiolitis in Canadian hospitals including fluid management and parameters to initiate, escalate and discontinue HFNC support. METHODS AND ANALYSIS This is a multicentre retrospective cohort study including hospitalised patients aged 0-24 months with bronchiolitis requiring support with HFNC between January 2017 and December 2021. Clinical data will be collected from patient medical records from Canadian hospitals (n=12), including academic and community centres. HFNC failure will be defined as the need for escalation to non-invasive or invasive mechanical ventilation. Factors associated with HFNC failure will be analysed using logistic regression. Descriptive statistics will be used to describe practice variations of HFNC utilisation and management. ETHICS AND DISSEMINATION Approval from the Research Ethics Boards (REBs) has been obtained for each participating study site prior to onset of data collection including Clinical Trials Ontario for all Ontario hospital sites and REBs from British Columbia Children's Hospital, Stollery Children's Hospital, Montreal Children's Hospital and CHU Sainte-Justine. Study results will be disseminated through presentation at national/international conferences and publication in high-impact, peer-reviewed journals.
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Affiliation(s)
| | - Chiara Fricano
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Farah Abdulsatar
- Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Nicole Bechard
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Jagraj Singh Brar
- Children's Hospital at London Health Sciences Centre, London, Ontario, Canada
| | - Olivier Drouin
- Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - Jessica L Foulds
- Department of Pediatrics, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
| | - Lucia Giglia
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Peter J Gill
- Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ronish Gupta
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Patricia Li
- Pediatrics, McGill University, Montreal, Quebec, Canada
| | | | | | - Mahmoud Sakran
- Department of Pediatrics, Queen's University, Kingston, Ontario, Canada
- Lakeridge Health Oshawa Hospital, Oshawa, Ontario, Canada
| | - Claire Seaton
- BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Anupam Sehgal
- Department of Pediatrics, Queen's University, Kingston, Ontario, Canada
- Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | | | - Lawrence Mbuagbaw
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Gita Wahi
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- McMaster Children's Hospital, Hamilton, Ontario, Canada
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Nascimento MS, Zólio BA, Vale LAPA, Silva PADL, Souza TS, Gonçalves LHR, Fascina LP, do Prado C. ROX index as a predictor of failure of high-flow nasal cannula in infants with bronchiolitis. Sci Rep 2024; 14:389. [PMID: 38172405 PMCID: PMC10764845 DOI: 10.1038/s41598-024-51214-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 01/02/2024] [Indexed: 01/05/2024] Open
Abstract
High-flow nasal cannula (HFNC) is a relatively recent therapy that has been used to treat respiratory failure. Until now, the criterion for failure requiring escalation to other forms of ventilatory support has remained unclear. This study evaluated how the ROX index predicts the success or failure of HFNC in infants with bronchiolitis. A prospective, observational, multicenter study was conducted in 2 pediatric ICUs. The data were collected at 7 moments. Patients were categorized into failure and success groups according to HFNC. A total of 102 infants were included, 18(17.6%) of whom failed HFNC therapy. For the ROX index, significant differences were observed between the failure 5.8(95%CI 4.7-7.1) and success 7.7(95%CI 7.2-8.2) groups (p = 0.005) at the 12 h evaluation. According to the analysis of the performance of the ROX index, the AUC at 12 h was 0.716(95%CI 0.591-0.842; p = 0.016). The best cutoff range for the ROX index at 12 h was 6.50-7.18, with a sensitivity of 42% and a specificity of 66% at the cutoff of 6.50, and a sensitivity of 92% and a specificity of 54% at the cutoff of 7.18. We concluded that the ROX index could be effective at predicting the failure of HFNC therapy in infants with bronchiolitis beginning at 12 h after installation.
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Affiliation(s)
- Milena Siciliano Nascimento
- Departamento de Práticas Assistenciais, Hospital Israelita Albert Einstein, Avenue Albert Einstein, 627-701, São Paulo, SP, 05651-901, Brazil.
| | - Bianca Agostini Zólio
- Departamento Materno-Infantil, Vila Santa Catarina Municipal Hospital, São Paulo, Brazil
| | | | | | - Thereza Silva Souza
- Departamento Materno-Infantil, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Linus Pauling Fascina
- Departamento Materno-Infantil, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Cristiane do Prado
- Departamento Materno-Infantil, Hospital Israelita Albert Einstein, São Paulo, Brazil
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Tripathi S, Mcgarvey JS, Shaikh N, Meixsell LJ. Description and Validation of a Novel Score (Flow Index) as a Clinical Indicator of the Level of Respiratory Support to Children on High Flow Nasal Cannula. J Pediatr Intensive Care 2023; 12:173-179. [PMID: 37565018 PMCID: PMC10411057 DOI: 10.1055/s-0041-1731021] [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: 03/11/2021] [Accepted: 04/16/2021] [Indexed: 10/21/2022] Open
Abstract
This study's objective was to describe and validate flow index (flow rate × FiO 2 /weight) as a method to report the degree of respiratory support by high flow nasal cannula (HFNC) in children. We conducted a retrospective chart review of children managed with HFNC from January 1, 2015 to December 31, 2019. Variables included in the flow index (weight, fraction of inspired oxygen [FiO 2 ], flow rate) and outcomes (hospital and intensive care unit [ICU] length of stay [LOS], escalation to the ICU) were extracted from medical records. Max flow index was defined by the earliest timestamp when patients FiO 2 × flow rate was maximum. Step-wise regression was used to determine the relationship between outcome (LOS and escalation to ICU) and flow index. Fifteen hundred thirty-seven patients met the study criteria. The median first and maximum flow indexes of the population were 24.1 and 38.1. Both first and maximum flow indexes showed a significant correlation with the LOS ( r = 0.25 and 0.31, p < 0.001). Correlation for the index was stronger than that of the variables used to calculate them and remained significant after controlling for age, race, sex, and diagnoses. Mild, moderate, and severe categories of first and max flow index were derived using quartiles, and they showed significant age and diagnosis independent association with LOS. Patients with first flow index >20 and maximum flow index >59.5 had increased odds ratio of escalation to ICU (odds ratio: 2.39 and 8.08). The first flow index had a negative association with rapid response activation. Flow index is a valid measure for assessing the degree of respiratory support for children on HFNC.
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Affiliation(s)
- Sandeep Tripathi
- Department of Pediatrics, OSF HealthCare Children's Hospital of Illinois, Illinois, United States
| | - Jeremy S. Mcgarvey
- Healthcare Analytics, OSF Healthcare Children's Hospital of Illinois, Peoria, Illinois, United States
| | - Nadia Shaikh
- Department of Pediatrics, OSF HealthCare Children's Hospital of Illinois, Illinois, United States
| | - Logan J. Meixsell
- Healthcare Analytics, OSF Healthcare Children's Hospital of Illinois, Peoria, Illinois, United States
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5
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Choi SH, Kim DY, Song BY, Yoo YS. [Analysis of ROX Index, ROX-HR Index, and SpO 2/FIO 2 Ratio in Patients Who Received High-Flow Nasal Cannula Oxygen Therapy in Pediatric Intensive Care Unit]. J Korean Acad Nurs 2023; 53:468-479. [PMID: 37673820 DOI: 10.4040/jkan.22152] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/27/2023] [Accepted: 05/17/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE This study aimed to evaluate the use of the respiratory rate oxygenation (ROX) index, ROX-heart rate (ROX-HR) index, and saturation of percutaneous oxygen/fraction of inspired oxygen ratio (SF ratio) to predict weaning from high-flow nasal cannula (HFNC) in patients with respiratory distress in a pediatric intensive care unit. METHODS A total of 107 children admitted to the pediatric intensive care unit were enrolled in the study between January 1, 2017, and December 31, 2021. Data on clinical and personal information, ROX index, ROX-HR index, and SF ratio were collected from nursing records. The data were analyzed using an independent t-test, χ² test, Mann-Whitney U test, and area under the curve (AUC). RESULTS Seventy-five (70.1%) patients were successfully weaned from HFNC, while 32 (29.9%) failed. Considering specificity and sensitivity, the optimal cut off points for predicting treatment success and failure of HFNC oxygen therapy were 6.88 and 10.16 (ROX index), 5.23 and 8.61 (ROX-HR index), and 198.75 and 353.15 (SF ratio), respectively. The measurement of time showed that the most significant AUC was 1 hour before HFNC interruption. CONCLUSION The ROX index, ROX-HR index, and SF ratio appear to be promising tools for the early prediction of treatment success or failure in patients initiated on HFNC for acute hypoxemic respiratory failure. Nurses caring for critically ill pediatric patients should closely observe and periodically check their breathing patterns. It is important to continuously monitor three indexes to ensure that ventilation assistance therapy is started at the right time.
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Affiliation(s)
- Sun Hee Choi
- Hospice and Palliative Care Team, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Dong Yeon Kim
- Nursing Innovation Unit, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Byung Yun Song
- Healthcare Quality Policy Team, The Catholic Education Foundation, Seoul, Korea
| | - Yang Sook Yoo
- Department of Clinical Nursing, College of Nursing, The Catholic University of Korea, Seoul, Korea.
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Saelim K, Thirapaleka B, Ruangnapa K, Prasertsan P, Anuntaseree W. Predictors of high-flow nasal cannula failure in pediatric patients with acute respiratory distress. Clin Exp Pediatr 2022; 65:595-601. [PMID: 36457201 PMCID: PMC9742760 DOI: 10.3345/cep.2022.00241] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 08/06/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Heated humidified high-flow nasal cannula (HFNC) has gained popularity recently and is considered a standard respiratory support tool for pediatric patients with acute respiratory distress. However, data are limited on the bedside parameters that can predict HFNC failure in pediatric patients. PURPOSE To evaluate the performance of SpO2/FiO2 (SF) ratio, pediatric respiratory rate-oxygenation (pROX) index, and clinical respiratory score (CRS), for predicting the HFNC outcomes. METHODS This prospective observational study included 1- month to 15-year-old patients with acute respiratory distress who required HFNC support. The HFNC setting, vital signs, CRS, and treatment outcomes were recorded. Data were analyzed to determine the predictors of HFNC failure. RESULTS Eighty-two children participated in the study, 16 of whom (19.5%) did not respond to HFNC treatment (failure group). Pneumonia was the main reason for intubation (62.5%). Predictors of HFNC failure at 12 hours were: SF index ≤166 (sensitivity, 62.5%; specificity, 87.8%; area under the curve [AUC], 0.75), pROX index <132 (sensitivity, 68.7%; specificity, 84.8%; AUC, 0.77), and CRS ≥6 (sensitivity, 87.5%; specificity, 96.9%; AUC, 0.92). CONCLUSION The CRS was the most accurate predictor of HFNC failure in pediatric patients. A CRS ≥ 6 at 12 hours after HFNC initiation and pROX, a newly modified parameter, are helpful indicators of HFNC failure.
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Affiliation(s)
- Kantara Saelim
- Division of Pulmonology and Critical Care Medicine, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Thailand
| | - Busawan Thirapaleka
- Division of Pulmonology and Critical Care Medicine, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Thailand
| | - Kanokpan Ruangnapa
- Division of Pulmonology and Critical Care Medicine, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Thailand
| | - Pharsai Prasertsan
- Division of Pulmonology and Critical Care Medicine, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Thailand
| | - Wanaporn Anuntaseree
- Division of Pulmonology and Critical Care Medicine, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Thailand
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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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Murala DK, Levenbrown Y, Xiao W, Hossain J, Shaffer TH. Utilising pneuRIP device in determining the adequacy of respiratory support when weaning high-flow nasal cannula in paediatric patients with acute respiratory distress: A pilot study. J Paediatr Child Health 2022; 58:1548-1553. [PMID: 35652438 DOI: 10.1111/jpc.16031] [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: 02/10/2022] [Revised: 04/18/2022] [Accepted: 05/02/2022] [Indexed: 11/28/2022]
Abstract
AIM Recognition of paediatric respiratory distress and timely intervention is critical, especially during the weaning phase of support in paediatric acute respiratory failure, as weaning too aggressively can lead to further setbacks in a patient's recovery. We aimed to determine if pulmonary function measurements obtained with the pneuRIP device, a noninvasive pulmonary function testing device that provides measurements of labored breathing index (LBI), phase angle and %rib cage (%RC) contribution to breathing, will provide predictive values to assess the adequacy of respiratory support while weaning from HFNC. METHODS We reviewed patients ages 0-18 years admitted to the PICU for respiratory distress due to respiratory infections receiving HFNC. Patients with history of chronic lung disease and chronic neuromuscular disease with baseline habnormal breathing patterns were excluded. Phase angle, LBI and %RC were obtained every hour and with every wean of HFNC. Nine patients were enroled. RESULTS Mean LBI range remained 1.27-1.68 when LBI was plotted as a function of the HFNC flow rate. Mean values of %RC contribution to breathing ranged 43.65-57.12 as a function of the HFNC flow rate. No significant deviations existed in either %RC (P = 0.16) or LBI (P = 0.16) during the weaning of HFNC. Mean phase angle for all subjects was 41.48°-74.12° for the duration of wean and showed significant deviation from baseline during the weaning process (p = 0.001). CONCLUSIONS Measurements of LBI and %RC on the pneuRIP device effectively demonstrated tolerance of weaning HFNC during the recovery phase of acute respiratory failure from a respiratory infection.
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Affiliation(s)
- Deepika K Murala
- Department of Pediatrics, Nemours Children's Hospital, Delaware, Wilmington, Delaware, United States
| | - Yosef Levenbrown
- Division of Pediatric Critical Care, Nemours Children's Hospital, Delaware, Wilmington, Delaware, United States.,Department of Pediatrics, Sidney Kimmel Medical School of Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Wendi Xiao
- Nemours Biomedical Research, Nemours Children's Health, Wilmington, Delaware, United States.,Department of Applied Economics and Statistics, University of Delaware, Newark, Delaware, United States
| | - Jobayer Hossain
- Nemours Biomedical Research, Nemours Children's Health, Wilmington, Delaware, United States.,Department of Applied Economics and Statistics, University of Delaware, Newark, Delaware, United States
| | - Thomas H Shaffer
- Nemours Biomedical Research/Research Lung Center, Nemours Children's Health, Wilmington, Delaware, United States.,Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, United States.,Department of Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
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Trapani J, Efstathiou N. What's in our first online-only issue? Nurs Crit Care 2021; 26:4-6. [PMID: 33506617 DOI: 10.1111/nicc.12592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Josef Trapani
- Faculty of Health Sciences, University of Malta, Msida, Malta
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SpO 2/FiO 2 as a predictor of high flow nasal cannula outcomes in children with acute hypoxemic respiratory failure. Sci Rep 2021; 11:13439. [PMID: 34188123 PMCID: PMC8242081 DOI: 10.1038/s41598-021-92893-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/14/2021] [Indexed: 11/16/2022] Open
Abstract
The high-flow nasal cannula (HFNC) is a useful treatment modality for acute hypoxemic respiratory failure (AHRF) in children. We compared the ability of the oxygen saturation to fraction of inspired oxygen ratio (S/F) and arterial oxygen partial pressure to fraction of inspired oxygen ratio (P/F) to predict HFNC outcomes in children with AHRF. This study included children treated with HFNC due to AHRF from April 2013 to March 2019 at the Severance Children’s Hospital. HFNC failure was defined as the need for mechanical ventilation. Trends of S/F and P/F during HFNC were analyzed. To predict HFNC outcomes, a nomogram was constructed based on predictive factors. A total of 139 patients with arterial blood gas data were included in the S/F and P/F analyses. S/F < 230 at initiation showed high prediction accuracy for HFNC failure (area under the receiver operating characteristic curve: 0.751). Univariate analyses identified S/F < 230 at HFNC initiation and < 200 at 2 h (odds ratio [OR] 12.83, 95% CI 5.06–35.84), and hemato-oncologic disease (OR 3.79, 95% CI 1.12–12.78) as significant predictive factors of HFNC failure. The constructed nomogram had a highly predictive performance, with a concordance index of 0.765 and 0.831 for the exploratory and validation groups, respectively. S/F may be used as a predictor of HFNC outcomes. Our nomogram with S/F for HFNC failure within 2 h may prevent delayed intubation in children with AHRF.
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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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Koyauchi T, Yasui H, Enomoto N, Hasegawa H, Hozumi H, Suzuki Y, Karayama M, Furuhashi K, Fujisawa T, Nakamura Y, Inui N, Yokomura K, Suda T. Pulse oximetric saturation to fraction of inspired oxygen (SpO 2/FIO 2) ratio 24 hours after high-flow nasal cannula (HFNC) initiation is a good predictor of HFNC therapy in patients with acute exacerbation of interstitial lung disease. Ther Adv Respir Dis 2021; 14:1753466620906327. [PMID: 32046604 PMCID: PMC7016313 DOI: 10.1177/1753466620906327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND High-flow nasal cannula (HFNC) oxygen therapy provides effective respiratory management in patients with hypoxemic respiratory failure. However, the efficacy and tolerability of HFNC for patients with acute exacerbation of interstitial lung disease (AE-ILD) have not been established. This study was performed to assess the efficacy and tolerability of HFNC for patients with AE-ILD and identify the early predictors of the outcome of HFNC treatment. METHODS We retrospectively reviewed the records of patients with AE-ILD who underwent HFNC. Overall survival, the success rate of HFNC treatment, adverse events, temporary interruption of treatment, discontinuation of treatment at the patient's request, and predictors of the outcome of HFNC treatment were evaluated. RESULTS A total of 66 patients were analyzed. Of these, 26 patients (39.4%) showed improved oxygenation and were successfully withdrawn from HFNC. The 30-day survival rate was 48.5%. No discontinuations at the patient's request were observed, and no serious adverse events occurred. The pulse oximetric saturation to fraction of inspired oxygen (SpO2/FIO2) ratio 24 h after initiating HFNC showed high prediction accuracy (area under the receiver operating characteristic curve, 0.802) for successful HFNC treatment. In the multivariate logistic regression analysis, an SpO2/FIO2 ratio of at least 170.9 at 24 h after initiation was significantly associated with successful HFNC treatment (odds ratio, 51.3; 95% confidence interval, 6.13-430; p < 0.001). CONCLUSIONS HFNC was well tolerated in patients with AE-ILD, suggesting that HFNC is a reasonable respiratory management for these patients. The SpO2/FIO2 ratio 24 h after initiating HFNC was a good predictor of successful HFNC treatment. The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
- Takafumi Koyauchi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.,Department of Respiratory Medicine, Respiratory Disease Center, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Hideki Yasui
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi Ward, Hamamatsu, Shizuoka 431-3192, Japan; Department of Emergency and Disaster Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Noriyuki Enomoto
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Hirotsugu Hasegawa
- Department of Respiratory Medicine, Respiratory Disease Center, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Hironao Hozumi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yuzo Suzuki
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Masato Karayama
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Kazuki Furuhashi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Tomoyuki Fujisawa
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yutaro Nakamura
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Naoki Inui
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Koshi Yokomura
- Department of Respiratory Medicine, Respiratory Disease Center, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
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Chang CC, Lin YC, Chen TC, Lin JJ, Hsia SH, Chan OW, Lee EP. High-Flow Nasal Cannula Therapy in Children With Acute Respiratory Distress With Hypoxia in A Pediatric Intensive Care UnitA Single Center Experience. Front Pediatr 2021; 9:664180. [PMID: 34026694 PMCID: PMC8139340 DOI: 10.3389/fped.2021.664180] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/06/2021] [Indexed: 11/13/2022] Open
Abstract
Aim: High-flow nasal cannulas (HFNCs) show potential in the application of positive pressure, improving gas exchange, and decreasing work of breathing in patients with acute respiratory distress. The aims of this study were to elucidate the indications for HFNC therapy in children of all ages and diagnoses, and to evaluate the efficacy and risk factors for failure of HFNC therapy in children with acute respiratory distress with hypoxia in a pediatric intensive care unit. Methods: We conducted this retrospective cohort study at a tertiary pediatric intensive care unit between January 1, 2018 and December 31, 2020. All children, from 1 month to 18 years of age, with acute respiratory distress with hypoxia and HFNC therapy were eligible. The clinical data were reviewed. Results: One hundred and two children met the eligibility criteria for the study, of whom 57 (55.9%) were male, and the mean age was 7.00 6.79 years. Seventy-eight (76.5%) of the children had underlying disorders. The most common indications for the use of HFNC therapy were pneumonia (40, 39.2%), sepsis-related respiratory distress (17, 16.7%), and bronchiolitis (16, 15.7%). The failure rate was 15.7% (16 of 102 children). Higher initial and maximum fraction of inspiration O2 levels and lower initial and lowest SpO2/FiO2 (S/F) ratio were early and possible signs of failure requiring escalation of respiratory support. Conclusion: In our population, we found that HFNC therapy could be initiated as the first-line therapy for various etiologies of acute respiratory distress with hypoxia in a pediatric intensive care unit and for all age groups.
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Affiliation(s)
- Chih-Ching Chang
- Department of Respiratory Therapy, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yi-Chen Lin
- Chang Gung University School of Medicine, Taoyuan, Taiwan
| | - Tzu-Chun Chen
- Chang Gung University School of Medicine, Taoyuan, Taiwan
| | - Jainn-Jim Lin
- Department of Respiratory Therapy, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Chang Gung University School of Medicine, Taoyuan, Taiwan.,Division of Pediatric Critical Care Medicine and Pediatric Neurocritical Care Center, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shao-Hsuan Hsia
- Department of Respiratory Therapy, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Chang Gung University School of Medicine, Taoyuan, Taiwan.,Division of Pediatric Critical Care Medicine and Pediatric Neurocritical Care Center, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Oi-Wa Chan
- Department of Respiratory Therapy, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Chang Gung University School of Medicine, Taoyuan, Taiwan.,Division of Pediatric Critical Care Medicine and Pediatric Neurocritical Care Center, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - En-Pei Lee
- Department of Respiratory Therapy, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Chang Gung University School of Medicine, Taoyuan, Taiwan.,Division of Pediatric Critical Care Medicine and Pediatric Neurocritical Care Center, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Ide N, Allen G, Ashworth HC, Dada S. Critical Breaths in Transit: A Review of Non-invasive Ventilation (NIV) for Neonatal and Pediatric Patients During Transportation. Front Pediatr 2021; 9:667404. [PMID: 34055699 PMCID: PMC8155575 DOI: 10.3389/fped.2021.667404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 04/15/2021] [Indexed: 12/24/2022] Open
Abstract
Respiratory illnesses are a leading cause of death for children worldwide, with the majority of these cases occurring from preterm birth complications or acute respiratory infections. Appropriate respiratory intervention must be provided quickly to lower the chances of death or permanent harm. As a result, respiratory support given in prehospital and interfacility transport can substantially improve health outcomes for these patients, particularly in areas where transportation time to appropriate facilities is lengthy. Existing literature supports the use of non-invasive ventilation (NIV), such as nasal or bilevel continuous positive airway pressure, as a safe form of respiratory support for children under 18 years old in certain transportation settings. This mini review summarizes the literature on pediatric NIV in transport and highlights significant gaps that future researchers should address. In particular, we identify the need to: solidify clinical guidelines for the selection of eligible pediatric patients for transport on NIV; explore the range of factors influencing successful NIV implementation during transportation; and apply appropriate best practices in low and middle income countries.
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Affiliation(s)
- Nellie Ide
- Department of Molecular and Cellular Biology, Harvard University, Cambridge, MA, United States
| | - Grace Allen
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA, United States
| | | | - Sara Dada
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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D'Alessandro M, Vanniyasingam T, Patel A, Gupta R, Giglia L, Federici G, Wahi G. Factors associated with treatment failure of high-flow nasal cannula among children with bronchiolitis: a single-centre retrospective study. Paediatr Child Health 2020; 26:e229-e235. [PMID: 34345322 DOI: 10.1093/pch/pxaa087] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 07/03/2020] [Indexed: 11/14/2022] Open
Abstract
Objectives Bronchiolitis is the most common viral lower respiratory tract infection in children under age 2 for which high-flow nasal cannula (HFNC) is increasingly used. Understanding factors associated with HFNC failure is important to identify patients at risk for respiratory deterioration. The objective of this study was to evaluate patient characteristics associated with HFNC failure in bronchiolitis. Methods A retrospective review of patients aged 0 to 24 months, with bronchiolitis who received HFNC within a single tertiary paediatric intensive care unit, between January 2014 and December 2018 was conducted. HFNC treatment failure was defined as escalation to non-invasive positive pressure or invasive mechanical ventilation. Multivariable regression analysis was used to identify demographic, clinical, and biochemical parameters associated with HFNC failure. Results Two hundred eight patients met inclusion criteria, of which 61 (29.33%) failed HFNC. Risk factors for HFNC failure included younger age (odds ratio [OR] 1.12; 95% confidence interval [CI] 1.03, 1.23; P=0.011) and a Modified Tal score greater than 5 at 4 hours of HFNC therapy (OR 2.81; 95% CI 1.04, 7.64; P=0.042). Duration of HFNC in hours was protective (OR 0.94; 95% CI 0.92, 0.96; P<0.001), such that deterioration is less likely once patients have remained stable on HFNC for a prolonged time. Conclusion This is the first study exploring predictors of HFNC failure among Canadian children with bronchiolitis. Patient age, HFNC duration, and Modified Tal score were associated with HFNC failure. These factors should be considered when initiating HFNC for bronchiolitis to identify patients at risk for deterioration.
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Affiliation(s)
| | - Thuva Vanniyasingam
- Department of Pediatrics, McMaster University, Hamilton, Ontario.,Biostatistics Unit, St. Joseph's Healthcare Hamilton, Hamilton, Ontario
| | - Ashaka Patel
- Department of Pediatrics, McMaster University, Hamilton, Ontario
| | - Ronish Gupta
- Department of Pediatrics, McMaster University, Hamilton, Ontario.,McMaster Children's Hospital, Hamilton, Ontario
| | - Lucy Giglia
- Department of Pediatrics, McMaster University, Hamilton, Ontario.,McMaster Children's Hospital, Hamilton, Ontario
| | - Giuliana Federici
- Department of Pediatrics, McMaster University, Hamilton, Ontario.,McMaster Children's Hospital, Hamilton, Ontario
| | - Gita Wahi
- Department of Pediatrics, McMaster University, Hamilton, Ontario.,McMaster Children's Hospital, Hamilton, Ontario
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White DK, Daubney ES, Harvey ME, Kayani R, Pathan N. Predicting use of high-flow nasal cannula therapy following extubation in paediatrics. Nurs Crit Care 2020; 26:42-47. [PMID: 32291892 DOI: 10.1111/nicc.12509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 03/05/2020] [Accepted: 03/17/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND High-flow nasal cannula (HFNC) therapy is widely used for respiratory support within paediatrics, most commonly used as a supportive measure in acute respiratory failure, aiming to avoid invasive mechanical ventilation (IMV). It is increasingly being used following extubation of critically ill children potentially at a higher risk of requiring re-intubation. Less data indicate the use for post-extubation HFNC therapy or possible clinical outcomes of this therapy. AIMS AND OBJECTIVES To identify reasons for, and variables to predict, the use of HFNC therapy post-extubation. DESIGN This was a retrospective case-control study. METHODS All children admitted to a nine-bedded regional paediatric intensive care unit requiring IMV between 18 December 2017 and 28 November 2018 were identified. The demographic data and bedside clinical and laboratory variables of the patients requiring HFNC therapy were compared with those who did not require HFNC. RESULTS There was no statistical difference in the median age and weight of children receiving HFNC therapy post-extubation compared with children not receiving it. In a logistic regression model, the highest ventilation (peak inspiratory pressure) and oxygen requirements in the first 24 hours of admission, along with the presence of comorbidity and use of HFNC therapy prior to intubation, predicted the use of HFNC following extubation, (r2 0.42, area under the receiver operating curve 0.843, P < .0001). CONCLUSIONS The direct correlation between high initial ventilatory requirements and pre-existing comorbidity was significant for the use of post-extubation HFNC therapy. This may be useful to stratify children in the use of HFNC therapy post-extubation in the critically ill population. RELEVANCE TO CLINICAL PRACTICE This study provides evidence that it may be possible to predict the use of HFNC therapy post-extubation. Avoiding unnecessary use of this therapy improves patient care while providing a positive economic impact.
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Affiliation(s)
- Deborah K White
- Paediatric Intensive Care Unit, Cambridge University Hospitals NHS Foundation Trust, Box 7, Addenbrooke's Hospital, Cambridge, UK.,Department of Paediatrics, Cambridge University, Box 116, Addenbrooke's Hospital, Cambridge, UK
| | - Esther S Daubney
- Paediatric Intensive Care Unit, Cambridge University Hospitals NHS Foundation Trust, Box 7, Addenbrooke's Hospital, Cambridge, UK.,Department of Paediatrics, Cambridge University, Box 116, Addenbrooke's Hospital, Cambridge, UK
| | - Mark E Harvey
- Paediatric Intensive Care Unit, Cambridge University Hospitals NHS Foundation Trust, Box 7, Addenbrooke's Hospital, Cambridge, UK
| | - Riaz Kayani
- Paediatric Intensive Care Unit, Cambridge University Hospitals NHS Foundation Trust, Box 7, Addenbrooke's Hospital, Cambridge, UK
| | - Nazima Pathan
- Paediatric Intensive Care Unit, Cambridge University Hospitals NHS Foundation Trust, Box 7, Addenbrooke's Hospital, Cambridge, UK.,Department of Paediatrics, Cambridge University, Box 116, Addenbrooke's Hospital, Cambridge, UK
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Vásquez-Hoyos P, Jiménez-Chaves A, Tovar-Velásquez M, Albor-Ortega R, Palencia M, Redondo-Pastrana D, Díaz P, Roa-Giraldo JD. [Factors associated to high-flow nasal cannula treatment failure in pediatric patients with respiratory failure in two pediatric intensive care units at high altitude]. Med Intensiva 2019; 45:195-204. [PMID: 31826812 DOI: 10.1016/j.medin.2019.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/24/2019] [Accepted: 10/18/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Acute respiratory failure is the leading cause of hospitalization in pediatrics. High-flow nasal cannulas (HFNCs) offer a new alternative, but the evidence and indications are still debated. The performance of HFNCs at high altitude has not been described to date. OBJECTIVE To describe the use of HFNCs in pediatric patients admitted with respiratory failure and explore the factors associated with treatment failure. METHODOLOGY A prospective cohort study was carried out in patients between 1 month and 18 years of age managed with HFNCs. The demographic and treatment response data were recorded at baseline and after 1, 6 and 24hours. The number of failures was determined, as well as the length of stay, complications and mortality. Patients with treatment failure were compared with the rest. RESULTS A total of 539 patients were enrolled. Infants (70.9%) of male sex (58.4%) and airway diseases such as asthma and bronchiolitis (61.2%) were more frequent. There were 53 failures (9.8%), with 21 occurring in the first 24hours. The median length of stay was 4 days (IQR 4); there were 5 deaths (0.9%) and 13 adverse events (epistaxis) (2.2%). Improvement was observed in vital signs and severity over time, with differences in the group that failed, but without interactions. The final logistic model established an independent relationship of failure between the hospital (OR 2.78, 95%CI 1.48-5.21) and the initial respiratory rate (OR 1.56, 95%CI 1.21-2.01). CONCLUSIONS HFNCs afford good clinical response, with few complications and a low failure rate. The differences found between institutions suggest a subjective relationship in the decision of therapy failure.
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Affiliation(s)
- P Vásquez-Hoyos
- Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia; Universidad Nacional de Colombia, Bogotá, Colombia; Hospital de San José de Bogotá, Bogotá, Colombia.
| | | | - M Tovar-Velásquez
- Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia; Hospital de San José de Bogotá, Bogotá, Colombia
| | - R Albor-Ortega
- Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
| | - M Palencia
- Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia; Hospital de San José de Bogotá, Bogotá, Colombia
| | - D Redondo-Pastrana
- Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia; Hospital de San José de Bogotá, Bogotá, Colombia
| | - P Díaz
- Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
| | - J D Roa-Giraldo
- Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia; Hospital de San José de Bogotá, Bogotá, Colombia
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Abstract
In caring for critically ill children, recognition and management often begins in the pediatric emergency department. A seamless transition in care is needed to ensure appropriate care to the sickest of children. This review covers the management of critically ill children in the pediatric emergency department beyond the initial stabilization for conditions such as acute respiratory failure and pediatric acute respiratory distress syndrome, traumatic brain injury, status epilepticus, congenital heart disease, and metabolic emergencies.
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High Flow Nasal Cannula Therapy for Bronchiolitis Across the Emergency Department and Acute Care Floor. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2018. [DOI: 10.1016/j.cpem.2018.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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