High-flow nasal cannula: recommendations for daily practice in pediatrics

Milési, Christophe; Boubal, Mathilde; Jacquot, Aurélien; Baleine, Julien; Durand, Sabine; Pons-Òdena, Martí; Cambonie, Gilles

doi:10.1186/s13613-014-0029-5

Cited by 154 publications

(136 citation statements)

References 51 publications

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“…Although the criteria for ICU admission are variable 16,34 and those for HFNC have not yet been established, 35 these escalated care interventions are generally limited to children with hypoxia and concern respiratory distress. 30 We did not include isolated use of intravenous or nasogastric hydration or supplemental oxygen in this definition because some institutions use intravenous or nasogastric hydration routinely on admission, 18 and the criteria for supplemental oxygen are disparate.…”

Section: Outcome Measuresmentioning

confidence: 99%

Predicting Escalated Care in Infants With Bronchiolitis

Freire¹,

Kuppermann

Zemek

et al. 2018

Pediatrics

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BACKGROUND AND OBJECTIVES:Early risk stratification of infants with bronchiolitis receiving airway support is critical for focusing appropriate therapies, yet the tools to risk categorize this subpopulation do not exist. Our objective was to identify predictors of "escalated care" in bronchiolitis. We hypothesized there would be a significant association between escalated care and predictors in the emergency department. We subsequently developed a risk score for escalated care. METHODS:We conducted a retrospective cohort study of previously healthy infants aged <12 months with bronchiolitis. Our primary outcome was escalated care (ie, hospitalization with high-flow nasal cannula, noninvasive or invasive ventilation, or intensive care admission). The predictors evaluated were age, prematurity, day of illness, poor feeding, dehydration, apnea, nasal flaring and/or grunting, respiratory rate, oxygen saturation, and retractions. . One of 217 (0.5%) infants without predictors received escalated care. The risk score ranged from 0 to 14 points, with the estimated risk of escalated care from 0.46% (0 points) to 96.9% (14 points). The area under the curve was 85%. CONCLUSIONS:We identified variables measured in the emergency department predictive of escalated care in bronchiolitis and derived a risk score to stratify risk of this outcome. This score may be used to aid management and disposition decisions.

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Section: Outcome Measuresmentioning

confidence: 99%

Predicting Escalated Care in Infants With Bronchiolitis

Freire¹,

Kuppermann

Zemek

et al. 2018

Pediatrics

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“…It also allows the administration of variable fraction of inspired oxygen (FiO 2 ) by minimising entrainment of room air. Flow rates described as constituting high flow are variable, ranging from 1 to 2 L/kg/min, with some evidence that higher flow rates deliver higher positive airway pressure,8 9 and that air leak around the nares and mouth opening significantly affect delivered pressure 10. There is currently limited evidence to support the efficacy and safety of HFNC for its use as a form of respiratory support in the treatment of the variety of indications for which it is currently used 7.…”

Section: Introductionmentioning

confidence: 99%

Is there a role for humidified heated high-flow nasal cannula therapy in paediatric emergency departments?

2016

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BackgroundHumidified heated high-flow nasal cannula (HFNC) therapy is a potentially useful form of non-invasive respiratory support for children with moderate respiratory distress and/or hypoxaemia. No prospective data support its use in the paediatric emergency department (ED). We introduced HFNC therapy into a paediatric ED and evaluated its use and failure rates.MethodsProspective observational study of all patients presenting to the Royal Children's Hospital, Australia, who received HFNC therapy between April 2013 and September 2013 (one southern hemisphere winter season). We assessed demographics, indications, failure rate, predictors of failure and adverse events.Results71 patients commenced HFNC therapy in ED over the study period. The median age was 9 months. The most common indication was bronchiolitis (49/71; 69%). Five (7%) of the patients failed HFNC and were escalated to other forms of respiratory support in ED, four to nasal continuous positive airway pressure and one required intubation. A further 21 (32%) failed HFNC therapy after intensive care unit (ICU) admission, giving a total failure of 28 (39%). There were no serious adverse events in ED, and one child with asthma developed air leak syndrome after transfer to the ICU.ConclusionsHFNC therapy may have a role in the paediatric ED as an easily administered and well tolerated form of non-invasive respiratory support, but about one-third of patients required escalation to a higher level of respiratory support. Further studies should assess the safety profile of HFNC in larger series, and define the role of HFNC in key respiratory conditions compared with other possible interventions.

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“…It was reported that in pediatric patients younger than 6 months, pharyngeal pressure was increased as flow increased, and at a level of 7 L/min the mean pressure and PEEP pressure were elevated to 4 and 6.5 cmH 2 O, respectively 9 . Furthermore, when humidified and heated oxygen-air mixture was Fraction of inspired oxygen administered to trachea, upper airway resistance was also reduced 10 .…”

Section: Discussionmentioning

confidence: 97%