Using a high-flow nasal cannula provides superior results to OxyMask delivery in moderate to severe bronchiolitis: a randomized controlled study

Ergül, Ayşe Betül; Calıskan, Emrah; Samsa, Hasan; Gokcek, Ikbal; Kaya, Ali Hakan; Zararsız, Gözde Ertürk; Torun, Yasemin Altuner

doi:10.1007/s00431-018-3191-1

Cited by 48 publications

(55 citation statements)

References 22 publications

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“…A growing body of evidences indicate that in spontaneously breathing subjects at risk of or with established lung injury, NHF is an effective strategy compared to conventional low flow oxygen [ 19 ]. The first clinical context for application of NHF was in neonates and infants where it is largely used to decrease risk of re-intubation [ 20 ] and manage acute respiratory pathologies such as bronchiolitis [ 21 , 22 ], asthma and croup [ 23 ]. In adults, NHF became extremely popular after publication of the FLORALI study [ 18 ] which demonstrated lower intubation and mortality rates in AHRF patients treated with NHF in comparison with noninvasive ventilation and conventional oxygen therapy.…”

Section: Resultsmentioning

confidence: 99%

Nasal high flow higher than 60 L/min in patients with acute hypoxemic respiratory failure: a physiological study

et al. 2020

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Background Nasal high flow delivered at flow rates higher than 60 L/min in patients with acute hypoxemic respiratory failure might be associated with improved physiological effects. However, poor comfort might limit feasibility of its clinical use. Methods We performed a prospective randomized cross-over physiological study on 12 ICU patients with acute hypoxemic respiratory failure. Patients underwent three steps at the following gas flow: 0.5 L/kg PBW/min, 1 L/kg PBW/min, and 1.5 L/kg PBW/min in random order for 20 min. Temperature and FiO2 remained unchanged. Toward the end of each phase, we collected arterial blood gases, lung volumes, and regional distribution of ventilation assessed by electrical impedance tomography (EIT), and comfort. Results In five patients, the etiology was pulmonary; infective disease characterized seven patients; median PaO2/FiO2 at enrollment was 213 [IQR 136–232]. The range of flow rate during NHF 1.5 was 75–120 L/min. PaO2/FiO2 increased with flow, albeit non significantly (p = 0.064), PaCO2 and arterial pH remained stable (p = 0.108 and p = 0.105). Respiratory rate decreased at higher flow rates (p = 0.014). Inhomogeneity of ventilation decreased significantly at higher flows (p = 0.004) and lung volume at end-expiration significantly increased (p = 0.007), but mostly in the non-dependent regions. Comfort was significantly poorer during the step performed at the highest flow (p < 0.001). Conclusions NHF delivered at rates higher than 60 L/min in critically ill patients with acute hypoxemic respiratory failure is associated with reduced respiratory rate, increased lung homogeneity, and additional positive pressure effect, but also with worse comfort.

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Section: Resultsmentioning

confidence: 99%

Nasal high flow higher than 60 L/min in patients with acute hypoxemic respiratory failure: a physiological study

et al. 2020

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“…Of the complementary approaches, only the Automated Full Search located all four of the trials that were found using the reference standard full update search. These were located between 6 and 12 months earlier than via the reference standard, in months 1 [24], 5 [25], and 7 [22,23]. The Automated Full Search also had the best precision among the complementary approaches (0.49%) and therefore the smallest number needed to read (NNR; 204 records).…”

Section: Resultsmentioning

confidence: 99%

LOCATE: A Prospective Evaluation of the Value of Leveraging Ongoing Citation Acquisition Techniques for Living Evidence Syntheses

Gates

Elliott

Gates

et al. 2020

Preprint

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Background. Living systematic reviews (LSRs) can expedite evidence synthesis by incorporating new evidence in real time. However, the methods needed to identify new studies in a timely manner are not well established. Objectives. To explore the value of complementary search approaches in terms of search performance, impact on results and conclusions, screening workload and feasibility compared to the reference standard.Methods. We developed three complementary search approaches for a systematic review on treatments for bronchiolitis: Automated Full Search, Pubmed Similar Articles, and Scopus Citing References. These were automated to retrieve results monthly; pairs of reviewers screened the records and commented on feasibility. After one year, we conducted a full update search (reference standard). For each complementary approach, we compared search performance (proportion missed, number needed to read [NNR]) and reviewer workload (number of records screened, time required) to the reference standard. We investigated the impact of the new trials on the effect estimate and certainty of evidence for the primary outcomes. We summarized comments about feasibility. Results. Via the reference standard, reviewers screened 505 titles/abstracts, 24 full texts, and identified four new trials (NNR 126.6; 12.4 hours). Of the complementary approaches, only the Automated Full Search located all four trials; these were located six to 12 months sooner than via the reference standard but did not alter the results nor certainty in the evidence. The Automated Full Search was the most resource-intensive approach (816 records screened; NNR 204.1; 17.1 hours). The Pubmed Similar Articles and Scopus Citing References approaches located far fewer records (452 and 244, respectively), thereby requiring less screening time (9.4 and 5.2 hours); however, each approach located only one of the four new trials. Reviewers found it feasible and convenient to conduct monthly screening for searches of this yield (median 15-65 records/month). Conclusions. The Automated Full Search was the most resource-intensive approach, but also the only to locate all of the newly published trials. Although the monthly screening time for the Pubmed Similar Articles and Scopus Citing Articles was far less, most relevant records were missed. These approaches were feasible to integrate into reviewer work processes.Study Protocol. Posted 25 October 2018 on the Open Science Framework, https://osf.io/wxebg/ doi: 10.17605/OSF.IO/6M28H.

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“…The HFNC has been demonstrated to have had a bene cial effect on treatment failure, but many authors criticize this effect for the absence of effects on other related outcomes. For example, only one clinical trial included in the previously mentioned systematic review (39) found an effect on LOS and the duration of oxygen therapy, and in none of the trials included was there an effect on the probability of PICU transfer. It is clear that there was no impact in this trial on the risk of admission to PICU because all patients with CN failure went onto HFNC, while those with HFNC failure went directly to PICU in these studies.…”

Section: Discussionmentioning

confidence: 99%

The Cost‑utility of Early use of High-flow Nasal Cannula in Bronchiolitis

Rodriguez

Acuña‐Cordero

Rodríguez‐Martínez

2020

Preprint

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Background: High-flow nasal cannula (HFNC) oxygen is a non-invasive ventilation system that was introduced as an alternative to CPAP (continuous positive airway pressure), with a marked increase in its use in pediatric care settings .This study aimed to evaluate the cost-effectiveness of early use of HFNC compared to oxygen by nasal cannula in an infant with bronchiolitis in the emergency setting. Methods: A decision tree model was used to estimate the cost-effectiveness of HFNC compared with oxygen by nasal cannula (control strategy) in an infant with bronchiolitis in the emergency setting. Cost data were obtained from a retrospective study on bronchiolitis from tertiary centers in Rionegro, Colombia, while utilities were collected from the literature. Results:The QALYs per patient calculated in the base-case model were 0.9141 (95% CI 0.913- 0.915) in the HFNC and 0.9105 (95% CI 0.910- 0.911) in control group. The cost per patient was US$368 (95% CI US$ 323- 411) in HFNC and US$441 (95% CI US$ 384-498) per patient in the control group.Conclusions: HFNC in emergency settings was cost-effective for the hospital treatment of an infant with bronchiolitis

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Using a high-flow nasal cannula provides superior results to OxyMask delivery in moderate to severe bronchiolitis: a randomized controlled study

Cited by 48 publications

References 22 publications

Nasal high flow higher than 60 L/min in patients with acute hypoxemic respiratory failure: a physiological study

Nasal high flow higher than 60 L/min in patients with acute hypoxemic respiratory failure: a physiological study

LOCATE: A Prospective Evaluation of the Value of Leveraging Ongoing Citation Acquisition Techniques for Living Evidence Syntheses

The Cost‑utility of Early use of High-flow Nasal Cannula in Bronchiolitis

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