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Lane JE, Ford T, Noelck M, Byrd C. High flow, low results: The limits of high flow nasal cannula in the treatment of bronchiolitis. Paediatr Respir Rev 2024:S1526-0542(24)00052-6. [PMID: 38964936 DOI: 10.1016/j.prrv.2024.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 06/03/2024] [Indexed: 07/06/2024]
Abstract
Bronchiolitis continues to be the most common cause of hospitalization in the first year of life. We continue to search for the remedy that will improve symptoms, shorten hospitalization and prevent worsening of disease. Although initially thought to be a promising therapy, large randomized controlled trials show us that high flow nasal cannula (HFNC) use is not that remedy. These trials show no major differences in duration of hospital stay, intensive care unit (ICU) admission rates, duration of stay in the ICU, duration of oxygen therapy, intubation rates, heart rate, respiratory rate or comfort scores. Additionally, practices regarding initiation, flow rates and weaning continue to vary from institution to institution and there are currently no agreed upon indications for its use. This reveals the need for evidence based guidelines on HFNC use in bronchiolitis.
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Affiliation(s)
- Jennifer E Lane
- Division of Hospital Medicine, Department of Pediatrics, Oregon Health and Science University, Portland, OR, United States.
| | - Taylor Ford
- Division of Hospital Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
| | - Michelle Noelck
- Division of Hospital Medicine, Department of Pediatrics, Oregon Health and Science University, Portland, OR, United States.
| | - Courtney Byrd
- Division of Hospital Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
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High-Flow Oxygen and Other Noninvasive Respiratory Support Therapies in Bronchiolitis: Systematic Review and Network Meta-Analyses. Pediatr Crit Care Med 2023; 24:133-142. [PMID: 36661419 DOI: 10.1097/pcc.0000000000003139] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES We present a systematic review on the effectiveness of noninvasive respiratory support techniques in bronchiolitis. DATA SOURCES Systematic review with pairwise meta-analyses of all studies and network meta-analyses of the clinical trials. STUDY SELECTION Patients below 24 months old with bronchiolitis who require noninvasive respiratory support were included in randomized controlled trials (RCTs), non-RCT, and cohort studies in which high-flow nasal cannula (HFNC) was compared with conventional low-flow oxygen therapy (LFOT) and/or noninvasive ventilation (NIV). DATA EXTRACTION Emergency wards and hospitalized patients with bronchiolitis. DATA SYNTHESIS A total of 3,367 patients were analyzed in 14 RCTs and 8,385 patients in 14 non-RCTs studies. Only in nonexperimental studies, HFNC is associated with a lower risk of invasive mechanical ventilation (MV) than NIV (odds ratio, 0.49; 95% CI, 0.42-0.58), with no differences in experimental studies. There were no differences between HFNC and NIV in other outcomes. HFNC is more effective than LFOT in reducing oxygen days and treatment failure. In the network meta-analyses of clinical trials, NIV was the most effective intervention to avoid invasive MV (surface under the cumulative ranking curve [SUCRA], 57.03%) and to reduce days under oxygen therapy (SUCRA, 79.42%), although crossover effect estimates between interventions showed no significant differences. The included studies show methodological heterogeneity, but it is only statistically significant for the reduction of days of oxygen therapy and length of hospital stay. CONCLUSIONS Experimental evidence does not suggest that high-flow oxygen therapy has advantages over LFOT as initial treatment nor over NIV as a rescue treatment.
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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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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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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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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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8
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Moreel L, Proesmans M. High flow nasal cannula as respiratory support in treating infant bronchiolitis: a systematic review. Eur J Pediatr 2020; 179:711-718. [PMID: 32232547 DOI: 10.1007/s00431-020-03637-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/10/2020] [Accepted: 03/16/2020] [Indexed: 10/24/2022]
Abstract
Bronchiolitis is a common respiratory illness in early childhood, often leading to hospitalization and associated healthcare costs. Low flow 100% oxygen through nasal prongs is the standard therapy for infants with bronchiolitis and hypoxemia. Nasal continuous positive airway pressure (nCPAP) or invasive ventilation is used in case of progressive respiratory failure. High flow heated and humidified oxygen therapy with delivery of an air-oxygen mixture up to 2 L/min/kg body weight via nasal prongs (referred to as high flow nasal cannula or HFNC) is a newer method for respiratory support. Initial data from retrospective studies were promising but should be interpreted with caution. A limited number of prospective randomized controlled trials (RCT) have now compared HFNC with either standard oxygen therapy (SOT) or nCPAP. In this review, we critically summarize the data from these RCTs with the aim to provide advice on how to position HFNC in clinical practice.Conclusion: HFNC is a safe mode of respiratory support that can be positioned between SOT and nCPAP as rescue therapy for children not adequately supported by SOT. It does not seem to shorten the duration of oxygen need nor the duration of hospital admission.What is Known:• HFNC is being used increasingly in the context of infant bronchiolitis. However, evidence on efficacy and safety are limited. Different published studies involve different disease severities and different pediatric settings.What is New:• In this review, we summarize data only from prospective RCTs with the aim to provide guidance on how to use HFNC.
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Affiliation(s)
- Lien Moreel
- Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Marijke Proesmans
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium.
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Korppi M. Prospective real-life studies are needed on bronchiolitis treatment protocols. Pediatr Pulmonol 2020; 55:853-854. [PMID: 32032462 DOI: 10.1002/ppul.24682] [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: 01/23/2020] [Accepted: 01/25/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Matti Korppi
- Faculty of Medicine and Life Sciences, Center for Child Health Research, University of Tampere and University Hospital, Tampere, Finland
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10
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Piper L, Stalets EL, Statile AM. Clinical Progress Note: High Flow Nasal Cannula Therapy for Bronchiolitis Outside the ICU in Infants. J Hosp Med 2020; 15:49-51. [PMID: 31891563 DOI: 10.12788/jhm.3328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/06/2019] [Accepted: 09/11/2019] [Indexed: 01/24/2023]
Affiliation(s)
- Laura Piper
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Erika L Stalets
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Angela M Statile
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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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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Heikkilä P, Korppi M. Oxygen administration in bronchiolitis: As humidified, or as heated and humidified? Pediatr Pulmonol 2019; 54:1343-1344. [PMID: 31050185 DOI: 10.1002/ppul.24349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 04/17/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Paula Heikkilä
- Tampere Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University and University Hospital, Tampere, Finland
| | - Matti Korppi
- Tampere Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University and University Hospital, Tampere, Finland
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13
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Hansen G, Hochman J, Garner M, Dmytrowich J, Holt T. Pediatric early warning score and deteriorating ward patients on high-flow therapy. Pediatr Int 2019; 61:278-283. [PMID: 30644645 DOI: 10.1111/ped.13787] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 12/06/2018] [Accepted: 01/09/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Delivery of non-invasive ventilation commonly occurs in the pediatric intensive care unit (PICU). With the advent of high-flow nasal cannula (HFNC), patients with respiratory distress may be rescued on the ward without a PICU admission. We evaluated our ward HFNC algorithm to determine its safety profile and independent predictors for non-responders, defined as requiring subsequent PICU admission. METHODS A retrospective chart review of patients <17 years of age admitted with respiratory distress between 2016 and 2017 was carried out. Pediatric Early Warning System (PEWS) respiratory score was used to assess the clinical response of patients requiring HFNC. Variables associated with non-responders were evaluated, and their PICU admission was studied for escalation of care and criticality. RESULTS Patients with comorbidities (P = 0.02) were more likely to require HFNC. Of the 18 patients initiated on HFNC, 44% (n = 8) remained on the ward. Non-responders (n = 10; 56%) had higher (2.7 vs 1.8; P = 0.03) and worsening (-0.1 vs 0.3; P = 0.05) PEWS respiratory scores 90 min after HFNC initiation. Eighty percent (n = 8) of non-responders required escalation to continuous positive airway pressure or bilevel positive airway pressure in the PICU. For both HFNC responders and non-responders, there were no requirements for intubation, evidence of air leak or difference in days of respiratory support. CONCLUSIONS High and worsening PEWS scores 90 min after HFNC initiation may indicate non-response when coupled with a standardized ward HFNC algorithm for respiratory distress. Further improvements may be seen with an earlier initiation of HFNC in the emergency department and more aggressive flow escalation on the ward.
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Affiliation(s)
- Gregory Hansen
- Division of Pediatric Critical Care, Department of Pediatrics, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Joshua Hochman
- Division of General Pediatrics, Department of Pediatrics, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Meghan Garner
- Division of Critical Care, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeffrey Dmytrowich
- Division of Pediatric Critical Care, Department of Pediatrics, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Tanya Holt
- Division of Pediatric Critical Care, Department of Pediatrics, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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de Benedictis FM. The Effectiveness of High-Flow Oxygen Therapy and the Fascinating Song of the Sirens. JAMA Pediatr 2019; 173:125-126. [PMID: 30575851 DOI: 10.1001/jamapediatrics.2018.3831] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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