Use of high flow nasal cannula oxygen (HFNCO) in infants with bronchiolitis on a paediatric ward: a 3-year experience

Kallappa, Chetana; Hufton, Maggie; Millen, Gerard Cathal; Ninan, Titus

doi:10.1136/archdischild-2014-306637

Cited by 49 publications

(48 citation statements)

References 2 publications

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“…[127][128][129][130] Clinical evidence suggests it reduces work of breathing 131,132 and may decrease need for intubation, [133][134][135][136] although studies are generally retrospective and small. The therapy has been studied in the ED 136,137 and the general inpatient setting, 134,138 as well as the ICU. The largest and most rigorous retrospective study to date was from Australia, 138 which showed a decline in intubation rate in the subgroup of infants with bronchiolitis (n = 330) from 37% to 7% after the introduction of high-flow nasal cannula, while the national registry intubation rate remained at 28%.…”

Section: Action Statement Profile Kas 6bmentioning

confidence: 99%

“…The therapy has been studied in the ED 136,137 and the general inpatient setting, 134,138 as well as the ICU. The largest and most rigorous retrospective study to date was from Australia, 138 which showed a decline in intubation rate in the subgroup of infants with bronchiolitis (n = 330) from 37% to 7% after the introduction of high-flow nasal cannula, while the national registry intubation rate remained at 28%. A single pilot for a randomized trial has been published to date.…”

Section: Action Statement Profile Kas 6bmentioning

confidence: 99%

See 1 more Smart Citation

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

Ralston¹,

Lieberthal²,

Meissner³

et al. 2014

Pediatrics

1,426

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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Section: Action Statement Profile Kas 6bmentioning

confidence: 99%

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

1,426

1,654

View full text Add to dashboard Cite

show abstract

“…In one study, 45 infants with moderately severe bronchiolitis who would have traditionally been transferred to a Paediatric High Dependency Unit for nasal CPAP received HHHFNC therapy on a general paediatric ward; 11 required escalation of respiratory support but HHHFNC therapy reduced the number of infants requiring transfer for CPAP. 15 In another study, data relating to 34 infants admitted to a PICU with bronchiolitis during two consecutive winters were retrospectively reviewed. 16 Nasal CPAP was used as first-line noninvasive respiratory support during the first winter and was replaced by HHHFNC (initial flow rate 1 L/kg/min, up to a maximum of 8 L/min) during the second winter.…”

Section: Role Of Hhhfnc Therapy In Bronchiolitismentioning

confidence: 99%

Heated humidified high-flow nasal cannula therapy in children

2014

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Heated humidified high-flow nasal cannula therapy (HHHFNC) was originally described as a mode of respiratory support in premature neonates and is now increasingly used in the management of acute respiratory failure in older infants and children. Heating and humidification of gas mixtures allow comfortable delivery of flow rates that match or exceed the patient's inspiratory flow rate. Emerging evidence from observational studies suggests that the use of HHHFNC therapy may be associated with reduced work of breathing, improved ventilation efficiency and a decreased need for intubation in children with respiratory insufficiency. There are several proposed mechanisms of action, and the potential for provision of unpredictable positive distending pressure has caused concern. Randomised controlled trial evidence comparing clinical outcomes with those achieved using other forms of respiratory support is, however, awaited. We review the proposed mechanisms of actions, indications, advantages and complications of HHHFNC therapy in children and describe our approach to its use in the paediatric ward environment.

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“…[38][39][40] A particularly strong retrospective study in Australia evaluated 330 infants with bronchiolitis and showed a decrease in intubation rates from 37% to 7% after the introduction of HFNC. 41 HFNC was associated with avoidance of ICU admission in a recent randomized trial of 200 children under the age of 2 years of age with moderate severe bronchiolitis who received either early initiation of HFNC or nasal cannula. 42 Early initiation of HFNC was also found to be important in an observational study that revealed an association between HFNC failure and low pretreatment pH and high pretreatment pCO 2 .…”

Section: Respiratory Supportmentioning

confidence: 99%

Improving Evidence Based Bronchiolitis Care

Cahill

Cohen

2018

Clinical Pediatric Emergency Medicine

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publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. Abstract:Bronchiolitis is the number one cause of hospitalization in infants during the first year of life. Clinical guidelines recom mend primarily supportive care and discourage use of pharmacotherapies and diagnostics. However, there con tinues to be widespread use of nonrecommended therapies and variation in the use of therapeutic interventions among hospitals in the United States.Here we review evidence-based man agement of this common disease in order to optimize resource utilization, decrease healthcare costs, and de crease unnecessary hospitalization. Current evidence does not support the routine use of chest radiographs, viral testing or laboratory evaluation in chil dren with bronchiolitis. In addition, rou tine administration of bronchodilators, including albuterol and nebulized epi nephrine, corticosteroids and hypertonic saline are not recommended for infants and children with bronchiolitis. Intrave nous or nasogastric hydration and nutri tional support, supplemental oxygen, and respiratory support are recom mended. Standardization of bronchiolitis care with evidence based institutional clinical pathways spanning ED to inpa tient care can help optimize resource utilization while simultaneously improv ing care of bronchiolitis and reducing hospital length of stays and costs.

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Use of high flow nasal cannula oxygen (HFNCO) in infants with bronchiolitis on a paediatric ward: a 3-year experience

Cited by 49 publications

References 2 publications

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

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

Heated humidified high-flow nasal cannula therapy in children

Improving Evidence Based Bronchiolitis Care

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