Physiologic Effect of High-Flow Nasal Cannula in Infants With Bronchiolitis

Hough, Judith; Pham, T.; Schibler, Andreas

doi:10.1097/pcc.0000000000000112

Cited by 112 publications

(92 citation statements)

References 32 publications

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“…HFNC delivers a gas mixture of oxygen/air, warmed to 34–37° Celsius with a relative humidity of almost 100%, at high flow rates. It reduces airway resistance, washes out end-expiratory gases and provides positive airway pressure, reducing work of breathing and improving in gas exchange [28–30]. It is also well tolerated [31].…”

Section: Discussionmentioning

confidence: 99%

Non-invasive respiratory support for infants with bronchiolitis: a national survey of practice

et al. 2017

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BackgroundBronchiolitis is a common respiratory illness of early childhood. For most children it is a mild self-limiting disease but a small number of children develop respiratory failure. Nasal continuous positive airway pressure (nCPAP) has traditionally been used to provide non-invasive respiratory support in these children, but there is little clinical trial evidence to support its use. More recently, high-flow nasal cannula therapy (HFNC) has emerged as a novel respiratory support modality. Our study aims to describe current national practice and clinician preferences relating to use of non-invasive respiratory support (nCPAP and HFNC) in the management of infants (<12 months old) with acute bronchiolitis.MethodsWe performed a cross-sectional web-based survey of hospitals with inpatient paediatric facilities in England and Wales. Responses were elicited from one senior doctor and one senior nurse at each hospital. We analysed the proportion of hospitals using HFNC and nCPAP; clinical thresholds for their initiation; and clinician preferences regarding first-line support modality and future research.ResultsThe survey was distributed to 117 of 171 eligible hospitals; 97 hospitals provided responses (response rate: 83%). The majority of hospitals were able to provide nCPAP (89/97, 91.7%) or HFNC (71/97, 73.2%); both were available at 65 hospitals (67%). nCPAP was more likely to be delivered in a ward setting in a general hospital, and in a high dependency setting in a tertiary centre. There were differences in the oxygenation and acidosis thresholds, and clinical triggers such as recurrent apnoeas or work of breathing that influenced clinical decisions, regarding when to start nCPAP or HFNC. More individual respondents with access to both modalities (74/106, 69.8%) would choose HFNC over nCPAP as their first-line treatment option in a deteriorating child with bronchiolitis.ConclusionsDespite lack of randomised trial evidence, nCPAP and HFNC are commonly used in British hospitals to support infants with acute bronchiolitis. HFNC appears to be currently the preferred first-line modality for non-invasive respiratory support due to perceived ease of use.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-017-0785-0) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Non-invasive respiratory support for infants with bronchiolitis: a national survey of practice

et al. 2017

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“…Our group has described the physiological effect of high flow in infants with bronchiolitis, and in neonates . We demonstrated in premature infants that flows delivered at 2 L/min or higher were equal to CPAP in maintaining the end‐expiratory level and ventilation distribution, and that flows of 8 L/min resulted in increased lung volume, and improved respiratory rate and oxygen saturation .…”

Section: Introductionmentioning

confidence: 99%

Nasal high flow in preterm infants: A dose‐finding study

Hough

Shearman

Jardine

et al. 2019

Pediatric Pulmonology

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Objective To investigate the relationship between applied flows of nasal high flow (NHF) and physiological outcomes and work of breathing (WOB), to identify an optimal delivery flow which results in reduced WOB in preterm infants. Design A prospective observational clinical study with randomly applied NHF rates. Patients and Setting Preterm infants within 72 hours of commencement of NHF respiratory support. Interventions Infants were initially placed on 8 L/min of NHF and flows of 2, 4, and 6 L/min were then applied in random order. Measurements and Results WOB was measured using transcutaneous electromyography and respiratory inductance plethysmography. Physiological variables were also recorded. Measurements taken 10 minutes after each flow change were compared with 8 L/min. Sixteen infants with a median gestational age of 28 (range 24‐31) weeks and postnatal age of 14 (2‐55) days were included in the study. The median flow rate before the study was 6 (4‐8) L/min and a fraction of inspired oxygen (FiO2) was 0.21 (0.21‐0.26). Changes in flow resulted in changes in activity in the front diaphragm (P = .027) and intercostals (P = .034). The electrical activity of the front diaphragm at 8 L/min was significantly lower than that at 2 L/min (P = .016). Respiratory rate was lowest at 6 L/min (P = .002) and SpO2/FiO2 was highest at 8 L/min (P < .04). Conclusion In preterm infants, changes in WOB resulting from randomly applied levels of NHF can be demonstrated by measuring the electrical activity of the diaphragm and intercostal muscles with transcutaneous electromyography. In combination with physiological measurements, the similarities in electrical activity between 4, 6, and 8 L/min suggest that these three flows may be equally as effective.

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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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Physiologic Effect of High-Flow Nasal Cannula in Infants With Bronchiolitis

Abstract: In infants with bronchiolitis, high-flow nasal cannula oxygen/air delivered at 8 L/min resulted in increases in end-expiratory lung volume and improved respiratory rate, FIO2, and SpO2.

Cited by 112 publications

References 32 publications

Non-invasive respiratory support for infants with bronchiolitis: a national survey of practice

Non-invasive respiratory support for infants with bronchiolitis: a national survey of practice

Nasal high flow in preterm infants: A dose‐finding study

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

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