High-Flow Nasal Cannula in the Pediatric ICU: Popular or Efficient?

Baudin, Florent; Pouyau, Robin

doi:10.4187/respcare.05720

Cited by 5 publications

(5 citation statements)

References 12 publications

(23 reference statements)

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“…1,2,20 It improves gas exchange and flushes anatomical dead space, and decreases work of breathing. 21 Therefore, HFNC is considered the primary respiratory support for patients with hypoxemic acute respiratory failure across ages. 21 Coletti et al stated that HFNC could be started as the first-line management for several diseases among children, such as bronchial asthma, or pneumonia, with a low failure rate of 10.1%, necessitating either noninvasive ventilation (5.6%) or required intubation (4.5%).…”

Section: Discussionmentioning

confidence: 99%

“…21 Therefore, HFNC is considered the primary respiratory support for patients with hypoxemic acute respiratory failure across ages. 21 Coletti et al stated that HFNC could be started as the first-line management for several diseases among children, such as bronchial asthma, or pneumonia, with a low failure rate of 10.1%, necessitating either noninvasive ventilation (5.6%) or required intubation (4.5%). 6 However, a recent study reported that the effectiveness of HFNC as initial respiratory support among children with moderate-to-severe acute viral bronchiolitis was less than that of nasal continuous positive airway pressure (nCPAP).…”

Section: Discussionmentioning

confidence: 99%

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Indications and Safety of High Flow Nasal Cannula in Pediatric Intensive Care Unit: Retrospective Single Center Experience in Saudi Arabia

Asseri¹,

Alqahtani²,

Alhanshani³

et al. 2021

PHMT

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Background: High flow nasal cannula (HFNC) is a new device for respiratory support. Its use continues to increase in pediatrics as its system is easily set up and well tolerated by patients. We aimed in this study to explore indications and safety of HFNC use and predictors of HFNC failure. Methods: Hospital records of 92 children with acute respiratory distress admitted to the pediatric intensive care unit (PICU) in Abha Maternity and Children Hospital from January 2018 until March 2020 and received HFNC therapy were studied. A data collection sheet was used that included patients' age, gender, the indication of HFNC, associated chronic diseases, previous admission to PICU, vital signs (initially, 8 hours and 48 hours after using HFNC), outcome after using HFNC, and reasons for HFNC failure. Results: After receiving HFNC, children's respiratory rate, heart rate, systolic blood pressure, and oxygen saturation improved significantly (p < 0.001, p < 0.001, p < 0.001, p = 0.005, and p < 0.001, respectively). Regarding laboratory findings, pH and serum bicarbonate improved significantly (p < 0.001 for both), while PaCO2 improved but not significantly. The failure rate of HFNC was 23.0%. HFNC failure rates were significantly higher among children with chronic diseases than those with no chronic disease (33.3% and 14.9%, respectively, p = 0.038) and among children with the air-leak syndrome (p < 0.001). After 48 hours of HFNC use, children who experienced HFNC failure had significantly higher respiratory and heart rates (p < 0.001 and p = 0.018, respectively), lower diastolic blood pressure (p = 0.011), and higher PaCO2 (p < 0.001). Conclusion:After HFNC use, significant improvements occur in all clinical parameters and laboratory values of children with respiratory distress, but about one-fourth of cases may experience HFNC failure. Predictors for HFNC failure include underlying chronic disease, low diastolic blood pressure, high respiratory rate, high heart rate, high initial PaCO2.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Indications and Safety of High Flow Nasal Cannula in Pediatric Intensive Care Unit: Retrospective Single Center Experience in Saudi Arabia

Asseri¹,

Alqahtani²,

Alhanshani³

et al. 2021

PHMT

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“…In children with severe AVB, heated humidified HFNC (HHHFNC) is emerging and increasingly being used as it is relatively safe, noninvasive, better tolerated, and avoid progression to invasive mechanical ventilation. [45][46][47][55][56][57][58] In a multicentric randomized controlled trial that compared 7 cm H 2 O nCPAP with HHHFNC (2 L/kg/min) in infants <6 months of age with moderate to severe AVB, showed that CPAP was superior to HHHFNC. 59 In a subsequent study by the same group, authors demonstrated that the higher flow rates (3 L/kg/min) of HFNC did not reduce the risk of failure when compared with lower flow (2 L/kg/min).…”

Section: Continuous Positive Airway Pressurementioning

confidence: 99%

“…42,43 Various noninvasive modes of oxygen delivery are being increasingly used such as high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), noninvasive positive pressure ventilation (NPPV), and bilevel positive airway pressure (BiPAP) which may obviate the need for invasive mechanical ventilation and complications related to it. [44][45][46][47][48]…”

Section: Supplemental Oxygenmentioning

confidence: 99%

Acute Viral Bronchiolitis: A Narrative Review

Angurana

Williams

Takia

2020

J Pediatr Intensive Care

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Acute viral bronchiolitis (AVB) is the leading cause of hospital admissions among infants in developed and developing countries and associated with increased morbidity and cost of treatment. This review was performed to guide the clinicians managing AVB in light of evidence accumulated in the last decade. We searched published English literature in last decade regarding etiology, diagnosis, treatment, and prevention of AVB using PubMed and Cochrane Database of Systematic Reviews. Respiratory syncytial virus is the most common causative agent. The diagnosis is mainly clinical with limited role of diagnostic investigations and chest radiographs are not routinely indicated. The management of AVB remains a challenge, as the role of various interventions is not clear. Supportive care in from of provision of heated and humidified oxygen and maintaining hydration are main interventions. The use of pulse oximetry helps to guide the administration of oxygen. Trials and systematic reviews evaluated various interventions like nebulized adrenaline, bronchodilators and hypertonic saline, corticosteroids, different modes of noninvasive ventilation (high-flow nasal cannula [HFNC], continuous positive airway pressure [CPAP], and noninvasive positive pressure ventilation [NPPV]), surfactant, heliox, chest physiotherapy, and antiviral drugs. The interventions which showed some benefits in infants and children with AVB are adrenaline and hypertonic saline nebulization, HFNC, CPAP, NIV, and surfactant. The routine administration of antibiotics, bronchodilators, corticosteroids, steam inhalation, chest physiotherapy, heliox, and antiviral drugs are not recommended.

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“…[1][2][3][4][5] Despite its popularity, a convincing level of evidence is lacking in children. [6][7][8] For subjects of all ages, a number of physiological advantages have been evaluated, including adequate humidification, 9,10 positive airway pressure, 11,12 washout of nasopharyngeal dead space, 13,14 and stable F IO 2 . 10,15 The physiological effects of HFNC on children have been investigated mostly in premature infants, 16,17 and data for other pediatric subjects are lacking.…”

Section: Introductionmentioning

confidence: 99%