Estimating inspired oxygen concentration delivered by nasal prongs in children with bronchiolitis

Sung, Valerie; Massie, John; Hochmann, M; Carlin, John B.; Jamsen, Kris; Robertson, Colin F.

doi:10.1111/j.1440-1754.2007.01171.x

Cited by 8 publications

(8 citation statements)

References 13 publications

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“…These results help to explain previous observations of high variability in FiO 2 delivered through nasal cannulas to neonates and infants, even at fixed nasal cannula flow rates [ 8 , 9 , 11 , 12 ]. Variability in FiO 2 was determined by variation in two breathing parameters: tidal volume and inhalation time.…”

Section: Discussionsupporting

confidence: 80%

“…Measurement of the FiO 2 delivered through nasal cannulas to patients is challenging because of the invasiveness of catheters required to sample gas from the hypopharynx [ 7 ], or the need to infer FiO 2 based on non-invasive surrogate measures if catheters are not used [ 8 , 9 ]. Moreover, simultaneous time-resolved measurements of inhaled oxygen concentration and breathing waveforms are difficult to obtain in vivo in neonates and infants, so previous studies have relied on assumed, rather than measured, breathing parameters when evaluating their influence on FiO 2 [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, simultaneous time-resolved measurements of inhaled oxygen concentration and breathing waveforms are difficult to obtain in vivo in neonates and infants, so previous studies have relied on assumed, rather than measured, breathing parameters when evaluating their influence on FiO 2 [ 10 ]. Nevertheless, previous in vivo studies are unanimous in concluding that FiO 2 delivered through nasal cannulas to neonates and infants is highly variable across individuals, even at fixed oxygen flow rates [ 8 , 9 , 11 , 12 ]. As a consequence, it has been remarked that the FiO 2 delivered to infants receiving oxygen through nasal cannulas frequently exceeds safe levels [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Variability in low-flow oxygen delivery by nasal cannula evaluated in neonatal and infant airway replicas

et al. 2022

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Background The nasal cannula is considered a trusted and effective means of administering low-flow oxygen and is widely used for neonates and infants requiring oxygen therapy, despite an understanding that oxygen concentrations delivered to patients are variable. Methods In the present study, realistic nasal airway replicas derived from medical scans of children less than 3 months old were used to measure the fraction of oxygen inhaled (FiO2) through nasal cannulas during low-flow oxygen delivery. Parameters influencing variability in FiO2 were evaluated, as was the hypothesis that measured FiO2 values could be predicted using a simple, flow-weighted calculation that assumes ideal mixing of oxygen with entrained room air. Tidal breathing through neonatal and infant nasal airway replicas was controlled using a lung simulator. Parameters for nasal cannula oxygen flow rate, nasal airway geometry, tidal volume, respiratory rate, inhalation/exhalation, or I:E ratio (ti/te), breath waveform, and cannula prong insertion position were varied to determine their effect on measured FiO2. In total, FiO2 was measured for 384 different parameter combinations, with each combination repeated in triplicate. Analysis of variance (ANOVA) was used to assess the influence of parameters on measured FiO2. Results Measured FiO2 was not appreciably affected by the breath waveform shape, the replica geometry, or the cannula position but was significantly influenced by the tidal volume, the inhalation time, and the nasal cannula flow rate. Conclusions The flow-weighted calculation overpredicted FiO2 for measured values above 60%, but an empirical correction to the calculation provided good agreement with measured FiO2 across the full range of experimental data.

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Section: Discussionsupporting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Variability in low-flow oxygen delivery by nasal cannula evaluated in neonatal and infant airway replicas

et al. 2022

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“…[106][107][108] Supplemental oxygen provided for infants not requiring additional respiratory support is best initiated with nasal prongs, although exact measurement of fraction of inspired oxygen is unreliable with this method. 109 Pulse oximetry is a convenient method to assess the percentage of hemoglobin bound by oxygen in children. Pulse oximetry has been erroneously used in bronchiolitis as a proxy for respiratory distress.…”

Section: Action Statement Profile Kas 6bmentioning

confidence: 99%

Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis

Ralston¹,

Lieberthal²,

Meissner³

et al. 2014

Pediatrics

1,429

1,654

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This guideline is a revision of the clinical practice guideline, “Diagnosis and Management of Bronchiolitis,” published by the American Academy of Pediatrics in 2006. The guideline applies to children from 1 through 23 months of age. Other exclusions are noted. Each key action statement indicates level of evidence, benefit-harm relationship, and level of recommendation. Key action statements are as follows:

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“…Supplemental oxygen delivered via headbox or nasal catheters is the mainstay of therapy for infants with hypoxaemia. However, despite the fact that the oxygen flow rate required to maintain satisfactory oxygenation is used as a proxy for severity, it has been recently demonstrated that it is not possible to reliably estimate the FiO 2 reliably from nasal oxygen flow rates in infants with bronchiolitis 30 . There are no universally accepted thresholds for introducing or weaning supplemental oxygen.…”

Section: Pharmacological Treatment At Presentationmentioning

confidence: 99%

Viral bronchiolitis for the clinician

Fitzgerald

2011

J Paediatrics Child Health

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Viral bronchiolitis is common, and about 98-99% of infants are managed in the home. Because about 95% of infants < 2 years old are infected with respiratory syncytial virus, however, bronchiolitis is the commonest reason for admission to hospital in the first 6 months of life. It is usually a self-limiting condition lasting around a week in previously well children. About 1% of infants are admitted to hospital, and about 10% of hospitalised infants will require admission to the intensive care unit. Respiratory syncytial virus is isolated from about 70% of infants hospitalised with bronchiolitis. The emphasis of hospital treatment is to ensure adequate hydration and oxygenation. Other than supplemental oxygen, little in the way of pharmacological treatment has been demonstrated to alter the course of the illness or the risk of wheezing in the months following bronchiolitis.

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Estimating inspired oxygen concentration delivered by nasal prongs in children with bronchiolitis

Abstract: In this study, it was not possible to estimate FiO(2) reliably from nasal oxygen flow rates in children with bronchiolitis. Nasal prong oxygen flow rates should be used with caution when assessing the severity of bronchiolitis in children.

Cited by 8 publications

References 13 publications

Variability in low-flow oxygen delivery by nasal cannula evaluated in neonatal and infant airway replicas

Variability in low-flow oxygen delivery by nasal cannula evaluated in neonatal and infant airway replicas

Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis

Viral bronchiolitis for the clinician

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