High flow nasal cannula use outside of the ICU; factors associated with failure

Betters, Kristina; Gillespie, Scott; Miller, Judson; Kotzbauer, David; Hebbar, Kiran

doi:10.1002/ppul.23626

Cited by 62 publications

(82 citation statements)

References 19 publications

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“…The rate of these patients was reported to be between 6% and 19% in the literature, which supports our rate of unresponsiveness with 16.2% . In two studies of HFNC therapy in pediatric respiratory distress, the median time to intubation of these patients was reported to be 5.5 and 7 h . These previous studies confirm our finding that the median time of HFNC therapy was 7 h in unresponsive patients.…”

Section: Discussionsupporting

confidence: 90%

“…The earliest studies emphasized that the requirement of endotracheal intubation decreased by the introduction of HFNC; however, HFNC still failed in a number of unpredictable patients . The rate of these patients was reported to be between 6% and 19% in the literature, which supports our rate of unresponsiveness with 16.2% . In two studies of HFNC therapy in pediatric respiratory distress, the median time to intubation of these patients was reported to be 5.5 and 7 h .…”

Section: Discussionsupporting

confidence: 60%

“…But, they excluded the children with a capillary or venous pCO 2 greater than 55 mm Hg prior to HFNC initiation. They also reported the lowest failure rate in literature with 6% . We conclude that the severity of respiratory distress in the study population is related to the failure rates.…”

Section: Discussionsupporting

confidence: 49%

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Early predictors of unresponsiveness to high‐flow nasal cannula therapy in a pediatric emergency department

Çağlar

Akgül

et al. 2018

Pediatric Pulmonology

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 60%

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Early predictors of unresponsiveness to high‐flow nasal cannula therapy in a pediatric emergency department

Çağlar

Akgül

et al. 2018

Pediatric Pulmonology

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“…Understandably, predictors for ward HFNC failure also differed. In our smaller sample we did not find bronchiolitis or intubation history to be predictive . Instead, the present predictors were related to worsening PEWS score.…”

Section: Discussioncontrasting

confidence: 90%

Pediatric early warning score and deteriorating ward patients on high‐flow therapy

Hansen

Hochman

Garner

et al. 2019

Pediatrics International

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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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“…They found that venous pCO 2 decreased in response to changes made based on these measurements, and these could be used to optimize ventilator settings for patients in the pediatric ICU. Betters et al examined the factors associated with failure of HFNC when initiated outside of the ICU . They included 231 patients and found a 6% failure rate, defined as the need for intubation or cardiorespiratory arrest.…”

Section: Introductionmentioning

confidence: 99%

Pediatric Pulmonology year in review 2017: Part 3

Ren

Muston

Yılmaz

et al. 2018

Pediatric Pulmonology

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Our journal covers a broad range of research and scholarly topics related to children's respiratory disorders. For updated perspectives on the rapidly expanding knowledge in our field, we will summarize the past year's publications in our major topic areas, as well as selected publications in these areas from the core clinical journal literature outside our own pages. The current review covers articles on neonatal lung disease, pulmonary physiology, and respiratory infection.Word count: 71 3

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High flow nasal cannula use outside of the ICU; factors associated with failure

Abstract: High FiO requirements, history of intubation, and cardiac co-morbidity are associative predictors of HFNC failure. Bronchiolitis patients may be treated with HFNC outside of the ICU with lower odds of failure. Pediatr Pulmonol. 2017;52:806-812. © 2017 Wiley Periodicals, Inc.

Cited by 62 publications

References 19 publications

Early predictors of unresponsiveness to high‐flow nasal cannula therapy in a pediatric emergency department

Early predictors of unresponsiveness to high‐flow nasal cannula therapy in a pediatric emergency department

Pediatric early warning score and deteriorating ward patients on high‐flow therapy

Pediatric Pulmonology year in review 2017: Part 3

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