Use of High-Flow Nasal Cannula Support in the Emergency Department Reduces the Need for Intubation in Pediatric Acute Respiratory Insufficiency

Wing, Robyn; James, Catherine; Maranda, Louise; Armsby, C. C.

doi:10.1097/pec.0b013e31827122a9

Cited by 137 publications

(157 citation statements)

References 9 publications

(6 reference statements)

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“…126 There is evidence that high-flow nasal cannula improves physiologic measures of respiratory effort and can generate continuous positive airway pressure in bronchiolitis. [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.…”

Section: Action Statement Profile Kas 6bmentioning

confidence: 99%

“…[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%

See 1 more Smart Citation

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

Ralston¹,

Lieberthal²,

Meissner³

et al. 2014

Pediatrics

1,421

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

1,421

1,654

View full text Add to dashboard Cite

show abstract

“…In a large case series of pediatric emergency department subjects who needed subsequent ICU care, introduction of HFNC in the emergency department was associated with fewer intubations in the emergency department, although there was no control group in this study, so this may have been due to other factors. 17 …”

Section: Discussionmentioning

confidence: 99%

Randomized Controlled Trial of Humidified High-Flow Nasal Oxygen for Acute Respiratory Distress in the Emergency Department: The HOT-ER Study

Jones¹,

Kamona²,

Doran³

et al. 2015

Respir Care

139

117

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BACKGROUND: Humidified high-flow nasal cannula (HFNC) is a novel method of oxygen delivery with increasing use in emergency departments and intensive care settings despite little evidence showing benefit over standard oxygen delivery methods (standard O 2 ). The aim of this study was to determine whether HFNC compared with standard O 2 given to subjects in acute respiratory distress would reduce the need for noninvasive ventilation or invasive ventilation. METHODS: This was a pragmatic open randomized controlled trial in adult subjects with hypoxia and tachypnea presenting to a tertiary academic hospital emergency department. The primary outcome was the need for mechanical ventilation in the emergency department. RESULTS: We screened 1,287 patients, 322 met entry criteria and 19 were excluded from analysis. Of these, 165 randomized to HFNC and 138 to standard O 2 were analyzed. Baseline characteristics were similar. In the HFNC group, 3.6% (95% CI 1.5-7.9%) versus 7.2% (95% CI 3.8 -13%) in the standard O 2 group required mechanical ventilation in the emergency department (P ‫؍‬ .16), and 5.5% (95% CI 2.8 -10.2%) in HFNC versus 11.6% (95% CI 7.2-18.1%) in the standard O 2 group required mechanical ventilation within 24 h of admission (P ‫؍‬ .053). There was no difference in mortality or stay. Adverse effects were infrequent; however, fewer subjects in the HFNC group had a fall in Glasgow coma score due to CO 2 retention, 0% (95% CI 0 -3%) versus 2.2% (95% CI 0.4 -6%). One in 12 subjects did not tolerate HFNC. CONCLUSIONS: HFNC was not shown to reduce the need for mechanical ventilation in the emergency department for subjects with acute respiratory distress compared with standard O 2 , although it was safe and may reduce the need for escalation of oxygen therapy within the first 24 h of admission.

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“…[21][22][23] A single-centre retrospective study of children with acute respiratory insufficiency (including asthma, pneumonia, bronchiolitis and croup) requiring PICU admission found introduction of HHHFNC therapy in the emergency department to be associated with a reduction in intubation rate from 16% to 8%. 24 There are some limited data relating to the potential use of HHHFNC therapy in paediatric cardiac patients. A recent single-centre, randomised trial compared HHHFNC therapy with low-flow oxygen therapy after extubation in postoperative cardiac patients under the age of 18 months.…”

Section: Role Of Hhhfnc Therapy In Respiratory Distress Due To Conditmentioning

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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Use of High-Flow Nasal Cannula Support in the Emergency Department Reduces the Need for Intubation in Pediatric Acute Respiratory Insufficiency

Abstract: High-flow nasal cannula used early in the development of pediatric ARI is associated with a decreased the need for intubation and mechanical ventilation.

Cited by 137 publications

References 9 publications

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

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

Randomized Controlled Trial of Humidified High-Flow Nasal Oxygen for Acute Respiratory Distress in the Emergency Department: The HOT-ER Study

Heated humidified high-flow nasal cannula therapy in children

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