Safety of High-Flow Nasal Cannula Outside the ICU for Previously Healthy Children With Bronchiolitis

Dadlez, Nina M.; Esteban-Cruciani, Nora; Khan, Asama; Shi, Yi; McKenna, Kevin J; Azzarone, Gabriella; Southern, William N.

doi:10.4187/respcare.06352

Cited by 14 publications

(6 citation statements)

References 21 publications

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“…from the PICU where it was introduced, to the paediatric wards and emergency departments (EDs), 4 7 where it is being used as first-line treatment. 8 Emerging evidence from small observational studies has pointed to the safety of HFNC in the less closely monitored ward setting as opposed to PICU, [8][9][10][11] and others have retrospectively identified potential reasons for failure of ward-based HFNC therapy. 12 However, this trend towards increasing use of HFNC outside of PICU is despite a lack of clear evidence demonstrating its superiority over conventional treatments, specifically standard oxygen therapy (SOT) and continuous positive airways pressure (CPAP).…”

Section: Open Accessmentioning

confidence: 99%

Efficacy and safety of high flow nasal oxygen for children with bronchiolitis: systematic review and meta-analysis

et al. 2021

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BackgroundTo assess the published evidence to establish the efficacy and safety of high flow oxygen cannula (HFNC) as respiratory support for children up to 24 months of age with bronchiolitis within acute hospital settings.MethodsWe searched eight databases up to March 2021. Studies including children up to 24 months of age with a diagnosis of bronchiolitis recruited to an randomised controlled trial were considered in the full meta-analysis. At least one arm of the study must include HFNC as respiratory support and report at least one of the outcomes of interest. Studies were identified and extracted by two reviewers. Data were analysed using Review Manager V.5.4.ResultsFrom 2943 article titles, 308 full articles were screened for inclusion. 23 studies met the inclusion criteria, 15 were included in the metanalyses. Four studies reported on treatment failure rates when comparing HFNC to standard oxygen therapy (SOT). Data suggests HFNC is superior to SOT (OR 0.45, 95% CI 0.36 to 0.57). Four studies reported on treatment failure rates when comparing HFNC to continuous positive airways pressure (CPAP). No significant difference was found between CPAP and HFNC (OR 1.64, 95% CI 0.96 to 2.79; p=0.07). Four studies report on adverse outcomes when comparing HFNC to SOT. No significant difference was found between HFNC & SOT (OR 1.47, 95% CI 0.54 to 3.99).ConclusionHFNC is superior to SOT in terms of treatment failure and there is no significant difference between HFNC and CPAP in terms of treatment failure. The results suggest HFNC is safe to use in acute hospital settings.

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Section: Open Accessmentioning

confidence: 99%

Efficacy and safety of high flow nasal oxygen for children with bronchiolitis: systematic review and meta-analysis

et al. 2021

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“…Initially developed for preterm infants, the application of this technology is rapidly spreading to include pediatric patients with various indications, including hospitalized bronchiolitis, 5 asthma, postextubation support, 6 and even adult hypoxemic respiratory failure 4 . In small children particularly, HFNC therapy may be better tolerated than traditional modes of noninvasive support, such as continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP) in part owing to its smaller nasal prong interface allowing activities like breastfeeding with greater ease 7,8 . In a recent multicenter, randomized clinical trial addressing acutely ill children aged 0–15 years assessed to require noninvasive respiratory support, HFNC compared with CPAP met the criterion for noninferiority for time to liberation from respiratory support 9,10 …”

Section: Introductionmentioning

confidence: 99%

“…4 In small children particularly, HFNC therapy may be better tolerated than traditional modes of noninvasive support, such as continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP) in part owing to its smaller nasal prong interface allowing activities like breastfeeding with greater ease. 7,8 In a recent multicenter, randomized clinical trial addressing acutely ill children aged 0-15 years assessed to require noninvasive respiratory support, HFNC compared with CPAP met the criterion for noninferiority for time to liberation from respiratory support. 9,10 The rising acceptance of HFNC has led to its increasing use outside the intensive care setting.…”

Section: Introductionmentioning

confidence: 99%

High flow nasal cannula therapy in the pediatric home setting

Ehrlich

Golan‐Tripto

Lavie

et al. 2022

Pediatric Pulmonology

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Background High‐flow nasal cannula (HFNC) therapy may be better tolerated than traditional noninvasive ventilation (NIV) and is rapidly gaining acceptance in pediatric acute care. In Israel, HFNC is approved for domestic use. We aim to describe its indications, efficacy, parental satisfaction, and safety. Methods Retrospective study of children treated with home HFNC therapy in three pediatric centers. Data included demographic parameters, indication of use, weight and days of hospitalization before and after initiation. Safety, tolerability, and parental satisfaction were assessed via standardized telephone questionnaire. Results Median (interquartile range [IQR]) age of initiating home HFNC in 75 children was 8.3 (2.2, 29.6) months. Indications were obstructive sleep apnea (33; 44%), airway malacia (19; 25%), chronic lung disease (15; 20%), neuromuscular disease (4; 5%), and postextubation support (4; 5%). Weight standard deviation score rose from −2.3 pre‐HFNC to −1.7 at 6.7 months post‐HFNC initiation, p < 0.001. Hospital admission days during the 2 months pre‐ versus post‐HFNC initiation were 22 (5.5, 60) and 5 (0, 14.7) respectively, p < 0.008. Median (IQR) parental satisfaction score was 5/5 (4, 5). Fifty of 60 (83%) respondents would recommend home HFNC to other families in a similar situation. There were no serious adverse events. Conclusion In our population, domestic HFNC appeared safe and well tolerated for a variety of indications. Its introduction was associated with improved weight gain, fewer hospitalization days and high parental satisfaction. Further work is required to characterize groups of children most likely to benefit from HFNC, as opposed to traditional modes of NIV.

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“…The shortened duration of invasive ventilation was demonstrated in a study regarding the implementation of HHFNC on a PICU [ 9 ]. Recently HHFNC has been used in more various settings such as ward and transport [ 10 – 13 ]. Previous studies have reported the safety of HHFNC use during interhospital transport [ 14 ], and a reduced requirement of invasive ventilation during transport [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical impact of implementing humidified high-flow nasal cannula on interhospital transport among children admitted to a PICU with respiratory distress: a cohort study

et al. 2021

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Background There is a limited evidence for humidified high-flow nasal cannula (HHFNC) use on inter-hospital transport. Despite this, its use during transport is increasing in children with respiratory distress worldwide. In 2015 HHFNC was implemented on a specialized pediatric retrieval team serving for Victoria. The aim of this study is to investigate the effect of the HHFNC implementation on the retrieval team on the paediatric intensive care unit (PICU) length of stay and respiratory support use. Methods We performed a cohort study using a comparative interrupted time-series approach controlling for patient and temporal covariates, and population-adjusted analysis. We studied 3022 children admitted to a PICU in Victoria with respiratory distress January 2010–December 2019. Patients were divided in pre-intervention era (2010–2014) and post-intervention era (2015–2019). Results 1006 children following interhospital transport and 2016 non-transport children were included. Median (IQR) age was 1.4 (0.7–4.5) years. Pneumonia (39.1%) and bronchiolitis (34.3%) were common. On retrieval, HHFNC was used in 5.0% (21/420) and 45.9% (269/586) in pre- and post-intervention era. In an unadjusted model, median (IQR) PICU length of stay was 2.2 (1.1–4.2) and 1.7 (0.9–3.2) days in the pre- and post-intervention era in transported children while the figures were 2.4 (1.3–4.9) and 2.1 (1.2–4.5) days in non-transport children. In the multivariable regression model, the intervention was associated with the reduced PICU length of stay (ratio 0.64, 95% confidential interval 0.49–0.83, p = 0.001) with the predicted reduction of PICU length of stay being − 10.6 h (95% confidential interval − 16.9 to − 4.3 h), and decreased respiratory support use (− 25.1 h, 95% confidential interval − 47.9 to − 2.3 h, p = 0.03). Sensitivity analyses including a model excluding less severe children showed similar results. In population-adjusted analyses, respiratory support use decreased from 4837 to 3477 person-hour per year in transported children over the study era, while the reduction was 594 (from 9553 to 8959) person-hour per year in non-transport children. With regard to the safety, there were no escalations of respiratory support mode during interhospital transport. Conclusions The implementation of HHFNC on interhospital transport was associated with the reduced PICU length of stay and respiratory support use among PICU admissions with respiratory distress.

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Safety of High-Flow Nasal Cannula Outside the ICU for Previously Healthy Children With Bronchiolitis

Cited by 14 publications

References 21 publications

Efficacy and safety of high flow nasal oxygen for children with bronchiolitis: systematic review and meta-analysis

Efficacy and safety of high flow nasal oxygen for children with bronchiolitis: systematic review and meta-analysis

High flow nasal cannula therapy in the pediatric home setting

Clinical impact of implementing humidified high-flow nasal cannula on interhospital transport among children admitted to a PICU with respiratory distress: a cohort study

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