Clinical Progress Note: High Flow Nasal Cannula Therapy for Bronchiolitis Outside the ICU in Infants

Piper, Laura; Stalets, Erika; Statile, Angela

doi:10.12788/jhm.3328

Cited by 6 publications

(5 citation statements)

References 15 publications

(61 reference statements)

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“…Through the nasal cannula, it provides a heated, humidi ed air-oxygen combination [2], [3]. The majority of the HFNC studies include respiratory infections such as bronchiolitis and pneumonia, especially in pediatric wards and emergency departments where it is used as rst-line treatment [4], [5]. Nasal high-ow provides some positive airway pressure and reduces the effort of breathing [6], [7] and the use of HFNC found to be well tolerated by children [8].…”

Section: Introductionmentioning

confidence: 99%

A comparison of the characteristics and outcomes of children with COVID-19 infections and children with other respiratory tract viral infections requiring high-flow nasal cannula

Besin,

Böncüoğlu,

Kıymet

et al. 2023

Preprint

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Background The aim of this single-center retrospective cohort study was to compare the clinical and laboratory differences, response, and outome of the patients requiring HFNC between two distinct groups, children with SARS-CoV-2 infection and children infected with other types of respiratory tract viruses during the COVID-19 pandemic. Methods This single-center cross-sectional study was conducted in the Pediatric Infectious Disease Ward and COVID-19 pademic wardç Data of the patients was collected from medical records including information on demographic characteristics (age, gender, and medical history); underlying diseases or co-morbidities, indications for HFNC and physical examination findings. If present laboratory examinations taken from the submissions were recorded. The indication and duration of HFNC, the length of hospital stay, admission or transfer to the PICU each patient’s stay in the hospital and if present the mortality rates by group were recorded.. Results During the study period a total of 171 patients were followed-up under HFNC. Among them, 8 patients were excluded from the study due to absence of arterial blood gas results before HFNC and 6 patients were excluded due to absence of PCR testing for COVID-19. At the final analysis, 157 patients under HFNC treatment were included including 22 COVID-19 PCR positive (group I ) and 135 COVID-19 PCR negative patients(Group II). Conclusions This study, patients with COVID-19 infections had longer durations of HFNC and hospital stay, in addition to high rate of transmission to PICU, suggesting a worser clinical outcome compared to infections with other viruses.

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Section: Introductionmentioning

confidence: 99%

A comparison of the characteristics and outcomes of children with COVID-19 infections and children with other respiratory tract viral infections requiring high-flow nasal cannula

Besin,

Böncüoğlu,

Kıymet

et al. 2023

Preprint

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“…17,18 Additionally, little medical evidence exists to guide the weaning of supplemental oxygen, leading to significant variability in clinical care. [18][19][20] This is further complicated by subjective evaluation of patients with bronchiolitis due to rapidly changing physical examination findings and poor validity of measurement instruments such as respiratory distress index. 21 The combination of limited evidence-based interventions, subjective evaluation, and no established standard of care for de-escalation of support contributes to overtreatment and increased resource utilization in the care of patients with bronchiolitis.…”

Section: Introductionmentioning

confidence: 99%

“…16 These data suggest that HFNC has become over-utilized in some patients who will not benefit from it, likely due to a lack of clear criteria for initiation of HFNC. 17,18 Additionally, little medical evidence exists to guide the weaning of supplemental oxygen, leading to significant variability in clinical care. [18][19][20] This is further complicated by subjective evaluation of patients with bronchiolitis due to rapidly changing physical examination findings and poor validity of measurement instruments such as respiratory distress index.…”

Section: Introductionmentioning

confidence: 99%

De-escalation of High-flow Respiratory Support for Children Admitted with Bronchiolitis: A Quality Improvement Initiative

Hoefert

Molina

Gardner

et al. 2022

Pediatric Quality &Amp; Safety

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Introduction: Bronchiolitis is the most common cause for hospitalization in the first year of life, with hypoxemia and acute respiratory failure as major determinants leading to hospitalization. In addition, the lack of existing guidelines for weaning and discontinuing supplemental oxygen, including high-flow nasal cannula, may contribute to prolonged hospitalization and increased resource utilization. Methods: This single-center quality improvement initiative assessed the effect of implementing a standardized care process for weaning and discontinuing high-flow oxygen for patients hospitalized with bronchiolitis. Patients aged 1–24 months with bronchiolitis admitted to the general wards or ICU step-down unit from February 1, 2018, and January 31, 2020 were included in the study. Primary outcomes included length of stay and time on supplemental oxygen, with time on high-flow oxygen and length of time in ICU step-down unit as secondary outcomes. Balancing measures included transfer rate to Pediatric Intensive Care Unit, intubation rate, 7- and 30-day readmission rates, and 7- and 30-day ED visits after discharge. Results: Following the standardized care process implementation, the mean length of stay decreased from 60.7 hours to 46.7 hours (P < 0.01). In addition, the mean time on any supplemental oxygen decreased by 47% (P < 0.01), the mean time on high-flow oxygen decreased by 45% (P < 0.01), and the mean time in the ICU step-down unit decreased by 27% (P =< 0.01). Balancing measures remained unchanged with no statistically significant differences. Conclusion: Implementing a standardized care process for weaning and discontinuing high-flow oxygen may reduce the length of stay and resource utilization for patients hospitalized with bronchiolitis.

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“…A s an appealing, physiologically plausible treatment, humidified oxygen delivery via high-flow nasal cannula (HFNC) has been rapidly adopted for the treatment of bronchiolitis despite weak evidence supporting its routine and early use in hypoxemic infants. 1 Although HFNC use has been associated with decreased work of breathing and lower rates of progression to invasive ventilation in some studies, the one large trial published on the topic found no difference between early HFNC and standard oxygen therapy on length of stay in hospital, duration of oxygen therapy, or rates of intubation. 2,3 No adequately powered studies have examined the effect of ward-based HFNC initiation on ICU transfer, an outcome that it is designed to prevent.…”

mentioning

confidence: 99%

Should the Pendulum Swing Back? More Transfers to the ICU After Implementing Ward-Based High-Flow Nasal Cannula Initiation Protocols for Bronchiolitis

Sklansky¹,

Mahant

2020

J Hosp Med

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As an appealing, physiologically plausible treatment, humidified oxygen delivery via high-flow nasal cannula (HFNC) has been rapidly adopted for the treatment of bronchiolitis despite weak evidence supporting its routine and early use in hypoxemic infants.1 Although HFNC use has been associated with decreased work of breathing and lower rates of progression to invasive ventilation in some studies, the one large trial published on the topic found no difference between early HFNC and standard oxygen therapy on length of stay in hospital, duration of oxygen therapy, or rates of intubation.2,3 No adequately powered studies have examined the effect of ward-based HFNC initiation on ICU transfer, an outcome that it is designed to prevent.

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Clinical Progress Note: High Flow Nasal Cannula Therapy for Bronchiolitis Outside the ICU in Infants

Cited by 6 publications

References 15 publications

A comparison of the characteristics and outcomes of children with COVID-19 infections and children with other respiratory tract viral infections requiring high-flow nasal cannula

A comparison of the characteristics and outcomes of children with COVID-19 infections and children with other respiratory tract viral infections requiring high-flow nasal cannula

De-escalation of High-flow Respiratory Support for Children Admitted with Bronchiolitis: A Quality Improvement Initiative

Should the Pendulum Swing Back? More Transfers to the ICU After Implementing Ward-Based High-Flow Nasal Cannula Initiation Protocols for Bronchiolitis

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