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Vasquez-Hoyos P, Jacome-Orozco AL, Rodriguez-Mayorga AP, Sepulveda-Forero LE, Escobar-Serna DP, Barajas JS, Obando-Belalcazar E, Salinas-Jaimes CM, Peralta-Palmezano JJ, Jimenez-Chavez A, Camacho-Jimenez RE, Dominguez-Rojas JA. Can the ROX index predict high-flow nasal cannula failure in children under 2 with lower respiratory tract infection? Pediatr Pulmonol 2024; 59:1246-1255. [PMID: 38305069 DOI: 10.1002/ppul.26895] [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] [Received: 06/27/2023] [Revised: 01/13/2024] [Accepted: 01/24/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE This study evaluates the ROX index's accuracy in predicting the success or failure of high-flow nasal cannula (HFNC) therapy in children under 2 years with acute respiratory failure (ARF) from lower respiratory tract infections. METHODS From January 2018 to 2021 we conducted this multicenter retrospective cohort study, which included patients aged 2-24 months. We aimed to assess HFNC therapy outcomes as either success or failure. The analysis covered patient demographics, diagnoses, vital signs, and ROX index values at intervals from 0 to 48 h after initiating HFNC. We used bivariate analysis, repeated measures ANOVA, multivariate logistic regression, and the area under the receiver operating characteristic (AUC-ROC) curve for statistical analysis. RESULTS The study involved 529 patients from six centers, with 198 females (37%) and a median age of 9 months (IQR: 3-15 months). HFNC therapy failed in 38% of cases. We observed significant variability in failure rates across different centers and physicians (p < .001). The ROX index was significantly associated with HFNC outcomes at all time points, showing an increasing trend in success cases over time (p < .001), but not in HFNC failure cases. Its predictive ability is limited, with AUC-ROC values ranging from 0.56 at the start to 0.67 at 48 h. CONCLUSION While the ROX index is associated with HFNC outcomes in children under 2 years, its predictive ability is modest, impacted by significant variability among patients, physicians, and centers. These findings emphasize the need for more reliable predictive tools for HFNC therapy in this patient population.
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Affiliation(s)
- Pablo Vasquez-Hoyos
- Department of Pediatrics, Universidad Nacional de Colombia, Bogota, Colombia
- Sociedad de Cirugía de Bogota Hospital de San Jose, Bogota, Colombia
- Department of Pediatrics, Fundacion Universitaria de Ciencias de la Salud, Bogota, Colombia
| | | | | | | | - Diana P Escobar-Serna
- Department of Pediatrics, Universidad Nacional de Colombia, Bogota, Colombia
- HOMI Fundacion Hospital Pediatrico la Misericordia, Bogota, Colombia
| | | | | | | | - Juan J Peralta-Palmezano
- Department of Pediatrics, Universidad Nacional de Colombia, Bogota, Colombia
- HOMI Fundacion Hospital Pediatrico la Misericordia, Bogota, Colombia
| | | | | | - Jesus A Dominguez-Rojas
- Hospital Nacional Hipólito Unanue, Lima, Peru
- Instituto Nacional de Salud del Niño, Lima, Peru
- Universidad Nacional Mayor de San Marcos, Lima, Peru
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Lin X, Li X, Qulian G, Bai Y, Liu Q. Efficay of high-flow nasal cannula in the paediatric population: A systematic evidence map. J Pediatr Nurs 2023; 73:e327-e363. [PMID: 37838549 DOI: 10.1016/j.pedn.2023.10.001] [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: 01/27/2023] [Revised: 09/30/2023] [Accepted: 10/01/2023] [Indexed: 10/16/2023]
Abstract
PROBLEM High-flow nasal cannula (HFNC) has been widely used in paediatric medicine as a non-invasive ventilation mode for respiratory support. However, the differences in its efficacy across different diseases and intervention types remain poorly understood. ELIGIBILITY CRITERIA An extensive literature search was performed across multiple academic databases to investigate the systematic reviews and meta-analyses of HFNC. SAMPLE This study included 35 systematic reviews and meta-analyses, which collectively examined 355 randomised controlled trials and assessed 51 outcome indicators. RESULTS The findings suggest that the existing clinical research evidence predominantly supports the therapeutic efficacy of HFNC. Notably, there is a significant focus on treating acute lower respiratory infection, hypoxaemia, bronchiolitis, and respiratory distress syndrome following extubation. However, concerning the respiratory status, the existing clinical research evidence mainly demonstrates the therapeutic benefits in post-extubation respiratory support and primary respiratory support. CONCLUSIONS The research on HFNC has witnessed significant expansion, primarily focusing on respiratory disorders, post-extubation respiratory support, conscious sedation, and related fields. The evidence mapping provides a systematic and comprehensive overview of the available evidence on HFNC therapy in paediatric patients. IMPLICATIONS This study systematically and comprehensively assessed the clinical subjects and populations involved in HFNC therapy. Notably, this study analyzed the trends, current status, and evidence gaps of research, and furnished decision-makers and relevant researchers with a more comprehensive reference basis.
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Affiliation(s)
- Xi Lin
- Department of Pediatrics, Children Hematological Oncology and Birth Defects Laboratory, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, PR China; Sichuan Clinical Research Center for Birth Defects, Luzhou, Sichuan 646000, PR China; Department of Nursing, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China
| | - Xiaoqin Li
- Department of Pediatrics, Children Hematological Oncology and Birth Defects Laboratory, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, PR China
| | - Guo Qulian
- Department of Pediatrics, Children Hematological Oncology and Birth Defects Laboratory, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, PR China; Sichuan Clinical Research Center for Birth Defects, Luzhou, Sichuan 646000, PR China
| | - Yongqi Bai
- Department of Pediatrics, Children Hematological Oncology and Birth Defects Laboratory, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, PR China; Department of Nursing, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China.
| | - Qin Liu
- Department of Pediatrics, Children Hematological Oncology and Birth Defects Laboratory, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, PR China.
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Buendía JA, Feliciano-Alfonso JE, Laverde MF. Systematic review and meta-analysis of efficacy and safety of continuous positive airways pressure versus high flow oxygen cannula in acute bronchiolitis. BMC Pediatr 2022; 22:696. [PMID: 36463122 PMCID: PMC9719123 DOI: 10.1186/s12887-022-03754-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/15/2022] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION There are a trend towards increasing use of High-Flow Nasal Cannula (HFNC), outside of paediatric intensive care unit. Give this trend is necessary to update the actual evidence and to assess available published literature to determinate the efficacy of HFNC over Continuous Positive Air Pressure (CPAP) as treatment for children with severe bronchiolitis. METHODS We searched MEDLINE, EMBASE, LILACS, and COCHRANE Central, and gray literature in clinical trials databases ( www. CLINICALTRIALS gov ), from inception to June 2022. The inclusion criteria for the literature were randomized clinical trials (RCTs) that included children < 2 years old, with acute moderate or severe bronchiolitis. All study selection and data extractions are performed independently by two reviewers. RESULTS The initial searches including 106 records. Only five randomized controlled trial that met the inclusion criteria were included in meta-analysis. The risk of invasive mechanical ventilation was not significantly different in CPAP group and HFNC group [OR: 1.18, 95% CI (0.74, 1.89), I² = 0%] (very low quality). The risk of treatment failure was less significantly in CPAP group than HFNC group [OR: 0.51, 95% CI (0.36, 0.75), I² = 0%] (very low quality). CONCLUSION In conclusion, there was no significant difference between HFNC and CPAP in terms of risk of invasive mechanical ventilation. CPAP reduces de risk of therapeutic failure with a highest risk of non severe adverse events. More trials are needed to confirm theses results.
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Affiliation(s)
- Jefferson Antonio Buendía
- grid.412881.60000 0000 8882 5269Research group in Pharmacology and Toxicology ”INFARTO”, Department of Pharmacology and Toxicology, University of Antioquia, Medellín, Colombia ,grid.412881.60000 0000 8882 5269Facultad de Medicina, Universidad de Antioquia, Carrera 51D, Medellín, Colombia
| | - John Edwin Feliciano-Alfonso
- grid.412881.60000 0000 8882 5269Research group in Pharmacology and Toxicology ”INFARTO”, Department of Pharmacology and Toxicology, University of Antioquia, Medellín, Colombia ,grid.10689.360000 0001 0286 3748Departamento de Medicina Interna, Universidad Nacional de Colombia, Bogota, Colombia
| | - Mauricio Fernandez Laverde
- grid.411140.10000 0001 0812 5789Unidad de Cuidado Intensivo Pediatrico. Hospital Pablo Tobon Uribe. Medellin. Facultad de Medicina, Universidad CES, Carrera 51D, Medellín, Colombia
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Steindor M, Wagner CE, Kavvalou A, Bock C, Olivier M, Stehling F. Indications and outcome of home high-flow nasal therapy in children, a single-center experience. Pediatr Pulmonol 2022; 57:2048-2052. [PMID: 35574827 DOI: 10.1002/ppul.25974] [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: 03/04/2022] [Revised: 05/03/2022] [Accepted: 05/13/2022] [Indexed: 11/09/2022]
Abstract
High-flow nasal therapy (HFNT) is a safe and simple way to deliver humidified air and oxygen for respiratory support in infants and children. HFNT is well established in an inpatient setting, but home HFNT lacks evidence. In the current study, we studied characteristics and outcomes of pediatric patients with home HFNT. In a monocentric retrospective analysis of data for 10 years (April 2010-April 2020), patient characteristics from the time point of the first discharge from hospital with home HFNT-treatment and the subsequent course were analyzed. Patients were divided into three HFNT indication groups: (1) bronchopulmonary dysplasia (BPD), (2) upper airway obstruction (UAO), and (3) other indications. Forty patients received home HFNT in the study period. Seventeen patients were treated for BPD, 15 for UAO, and 8 had other indications. Twenty-two patients (55%) were successfully weaned from HFNT (12 [70.6%] BPD, 7 [46.7%] UAO, 3 [37.5%] other), while seven patients (17.5%) died during follow-up (4 BPD, 2 UAO, 1 other). Twenty-three patients (57.5%) required (intermittent) additional oxygen application (14 [82.4%] BPD, 6 [40%] UAO, 4 [50%] other). Weaning success and need for additional oxygen were significantly more probable in BPD patients compared to the UOA group. In conclusion, HFNT plays an increasing role in home treatment of respiratory insufficiency of various etiologies in childhood. It often represents a temporary intervention, especially for children with BPD but might also serve as long-term treatment for children in whom other forms of ventilatory support are not feasible or desired.
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Affiliation(s)
- Mathis Steindor
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics III, Children's Hospital, University of Duisburg-Essen, Essen, Germany
| | - Carolin Ellen Wagner
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics III, Children's Hospital, University of Duisburg-Essen, Essen, Germany
| | - Alexandra Kavvalou
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics III, Children's Hospital, University of Duisburg-Essen, Essen, Germany
| | - Claudia Bock
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics III, Children's Hospital, University of Duisburg-Essen, Essen, Germany
| | - Margarete Olivier
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics III, Children's Hospital, University of Duisburg-Essen, Essen, Germany
| | - Florian Stehling
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics III, Children's Hospital, University of Duisburg-Essen, Essen, Germany
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Nolasco S, Manti S, Leonardi S, Vancheri C, Spicuzza L. High-Flow Nasal Cannula Oxygen Therapy: Physiological Mechanisms and Clinical Applications in Children. Front Med (Lausanne) 2022; 9:920549. [PMID: 35721052 PMCID: PMC9203852 DOI: 10.3389/fmed.2022.920549] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
High-flow nasal cannula (HFNC) oxygen therapy has rapidly become a popular modality of respiratory support in pediatric care. This is undoubtedly due to its ease of use and safety, which allows it to be used in a wide variety of settings, ranging from pediatric intensive care to patients' homes. HFNC devices make it possible to regulate gas flow and temperature, as well as allowing some nebulized drugs to be administered, features very useful in children, in which the balance between therapeutic effectiveness and adherence to treatment is pivotal. Although the physiological effects of HFNC are still under investigation, their mechanisms of action include delivery of fixed concentration of oxygen, generation of positive end-expiratory pressure, reduction of the work of breathing and clearance of the nasopharyngeal dead space, while providing optimal gas conditioning. Nevertheless, current evidence supports the use of HFNC mainly in moderate-to-severe bronchiolitis, whereas for asthma exacerbations and breath sleeping disorders there is a lack of randomized controlled trials comparing HFNC to continuous positive airway pressure (CPAP) and non-invasive ventilation (NIV), which are essentials for the identification of response and non-response predictors. In this regard, the development of clinical guidelines for HFNC, including flow settings, indications, and contraindications is urgently needed.
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Affiliation(s)
- Santi Nolasco
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- *Correspondence: Santi Nolasco
| | - Sara Manti
- Pediatric Pulmonology Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Salvatore Leonardi
- Pediatric Pulmonology Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Carlo Vancheri
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Lucia Spicuzza
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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Solana-Gracia R, Modesto i Alapont V, Bueso-Inchausti L, Luna-Arana M, Möller-Díez A, Medina A, Pérez-Moneo B. Changes in Ventilation Practices for Bronchiolitis in the Hospital Ward and Need for ICU Transfer over the Last Decade. J Clin Med 2022; 11:jcm11061622. [PMID: 35329951 PMCID: PMC8950048 DOI: 10.3390/jcm11061622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/02/2022] [Accepted: 03/14/2022] [Indexed: 11/16/2022] Open
Abstract
There is limited evidence of the potential benefits of the use of high-flow nasal cannula (HFNC) for the management of bronchiolitis in the ward. Our aim is to describe the ventilation trends for bronchiolitis in our hospital along with the introduction of an HFNC ward protocol and to determine the need for respiratory support escalation and transfer to an intensive care unit (ICU). A retrospective analytical observational study of children < 12 months old requiring admission for a first RSV bronchiolitis episode in a single centre from January 2009 to December 2018. The sample was divided into four groups according to the type of respiratory support that would ensure the clinical stability of the infants on admission. A total of 502 infants were recruited. The total number and percentage of patients admitted in the ward grew progressively over time. Simultaneously, there was an increase in HFNC and, paradoxically, an increase in ICU transfers. The risk of failure was higher for those who required HFNC or CPAP for clinical stabilisation in the first 12 h after admission. Moreover, the risk of failure was also higher in children with standard oxygen therapy promptly escalated to HFNC, especially if they had atelectasis/viral pneumonia, coinfections or a history of prematurity. Despite the limitations of a retrospective analysis, our study reflects usual clinical practice and no correlation was found between the usage of HFNC and a shorter length of hospital stay or less time spent on oxygen therapy.
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Affiliation(s)
- Ruth Solana-Gracia
- Department of Paediatrics, Hospital Universitario Infanta Leonor y Hospital Virgen de la Torre, 28031 Madrid, Spain;
- Correspondence: ; Tel.: +34-91-191-8000
| | | | - Leticia Bueso-Inchausti
- Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (L.B.-I.); (M.L.-A.); (A.M.-D.)
| | - María Luna-Arana
- Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (L.B.-I.); (M.L.-A.); (A.M.-D.)
| | - Ariadna Möller-Díez
- Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (L.B.-I.); (M.L.-A.); (A.M.-D.)
| | - Alberto Medina
- Paediatric Intensive Care Unit, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain;
| | - Begoña Pérez-Moneo
- Department of Paediatrics, Hospital Universitario Infanta Leonor y Hospital Virgen de la Torre, 28031 Madrid, Spain;
- Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (L.B.-I.); (M.L.-A.); (A.M.-D.)
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Zhong Z, Zhao L, Zhao Y, Xia S. Comparison of high flow nasal cannula and non-invasive positive pressure ventilation in children with bronchiolitis: A meta-analysis of randomized controlled trials. Front Pediatr 2022; 10:947667. [PMID: 35911840 PMCID: PMC9334708 DOI: 10.3389/fped.2022.947667] [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: 05/19/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The effects of high-flow nasal cannula (HFNC) compared to non-invasive positive pressure ventilation (NIPPV) on children with bronchiolitis remain unclear. METHODS This meta-analysis was performed following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement. Randomized controlled trials (RCTs) were identified from a comprehensive search in PubMed, EMBASE, Cochrane Library, and Web of Science without time and language limitations. Primary endpoints include the rate of treatment failure, the rate of need for intubation, and the pediatric intensive care unit (PICU) length of stay. RESULTS Five RCTs including 541 children of less than 24 months were enrolled in the meta-analysis. Compared to the NIPPV group, the rate of treatment failure was significantly higher in the HFNC treatment group (I 2 = 0.0%, P = 0.574; RR 1.523, 95% CI 1.205 to 1.924, P < 0.001). No significant difference was noted in the need for intubation (I 2 = 0.0%, P = 0.431; RR 0.874, 95% CI 0.598 to 1.276, P = 0.485) and the PICU length of stay (I 2 = 0.0%, P = 0.568; WMD = -0.097, 95% CI = -0.480 to 0.285, P = 0.618) between the HFNC group and the NIPPV treatment. CONCLUSION Compared to the NIPPV group, HFNC therapy was associated with a significantly higher treatment failure rate in children suffering from bronchiolitis. The intubation rate and the PICU length of stay were comparable between the two approaches.
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Affiliation(s)
- Zhaoshuang Zhong
- Department of Respiratory, Central Hospital, Shenyang Medical College, Shenyang, China
| | - Long Zhao
- Department of Respiratory, Central Hospital, Shenyang Medical College, Shenyang, China
| | - Yan Zhao
- Department of Respiratory, Central Hospital, Shenyang Medical College, Shenyang, China
| | - Shuyue Xia
- Department of Respiratory, Central Hospital, Shenyang Medical College, Shenyang, China
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