Comparative evaluation of high-flow nasal cannula and conventional oxygen therapy in paediatric cardiac surgical patients: a randomized controlled trial

Testa, Genni; Iodice, Francesca; Ricci, Zaccaria; Vitale, Vincenzo; Razza, Francesca De; Haiberger, Roberta; Iacoella, Claudia; Conti, Giorgio; Cogo, Paola

doi:10.1093/icvts/ivu171

Cited by 81 publications

(102 citation statements)

References 20 publications

(27 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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. 25 The partial pressure of oxygen/F i O 2 was similar between the two groups at baseline but much higher in the HHHFNC therapy group at all time points during the 48-hour study period. There was no difference in pCO 2 values at any time point.…”

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

confidence: 75%

Heated humidified high-flow nasal cannula therapy in children

2014

View full text Add to dashboard Cite

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.

show abstract

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

confidence: 75%

Heated humidified high-flow nasal cannula therapy in children

2014

View full text Add to dashboard Cite

show abstract

“…Previous single center studies have shown NIV to be an effective mode of respiratory support in the management of children with heart disease [6], including following cardiac surgery [4, 7, 8]. Our study represents the most comprehensive description to-date of NIV therapy in contemporary pediatric cardiac critical care, and the first to assess NIV therapy in a multi-institutional cohort.…”

Section: Discussionmentioning

confidence: 96%

Epidemiology of Noninvasive Ventilation in Pediatric Cardiac ICUs*

Romans

Schwartz

Costello

et al. 2017

Pediatric Critical Care Medicine

View full text Add to dashboard Cite

Objective To describe the epidemiology of noninvasive ventilation (NIV) therapy for patients admitted to pediatric cardiac intensive care units (CICU), and to assess practice variation across hospitals. Design Retrospective cohort study using prospectively collected clinical registry data. Setting Pediatric Cardiac Critical Care Consortium (PC4) clinical registry. Patients Patients admitted to CICUs at PC4 hospitals. Interventions None. Measurements and Main Results We analyzed all CICU encounters that included any respiratory support from 10/2013-12/2015. NIV therapy included high flow nasal cannula (HFNC) and positive airway pressure (PAP) support. We compared patient and, when relevant, perioperative characteristics of those receiving NIV to all others. Subgroup analysis was performed on neonates and infants undergoing major cardiovascular surgery. To examine duration of respiratory support we created a casemix-adjustment model and calculated adjusted mean durations of total respiratory support (MV + NIV), MV, and NIV. We compared adjusted duration of support across hospitals. The cohort included 8,940 encounters from 15 hospitals: 3,950 (44%) received NIV, 72% were neonates and infants. Medical encounters were more likely to include NIV than surgical. In surgical neonates and infants, 2,032 (55%) received postoperative NIV. Neonates, extracardiac anomalies, single ventricle, procedure complexity, preoperative respiratory support, MV duration, and postoperative disease severity were associated with NIV therapy (p<0.001 for all). Across hospitals, NIV use ranged from 32%-65%, and adjusted mean NIV duration ranged from 1-4 days (3 days observed mean). Duration of total adjusted respiratory support was more strongly correlated with duration of MV compared to NIV (Pearson's r=0.93 vs 0.71, respectively). Conclusions NIV use is common in CICUs, especially in patients admitted for medical conditions, infants, and those undergoing high complexity surgery. We observed wide variation in NIV use across hospitals, though the primary driver of total respiratory support time seems to be duration of MV.

show abstract

“…However, the value of CPAP is unstable (from 1 to 7 cm H 2 O) because of the leak around the nasal cannula and a closed mouth of the patients cannot always be guaranteed [16]. Due to the provision of distending pressure and increase in end-expiratory lung volume, some researchers proposed that it decreased airway resistance and flushed nasopharyngeal dead space, thereby contributing to the reduced work of breathing [17, 18]. Considering the suspected induced effects of HFNC on lung volumes [19], we hypothesized that early initiation of HFNC could minimize in part lung derecruitment after extubation.…”

Section: Discussionmentioning

confidence: 99%

Effect of High-Flow Nasal Cannula versus Conventional Oxygen Therapy for Patients with Thoracoscopic Lobectomy after Extubation

Qian

Liu³

et al. 2017

Canadian Respiratory Journal

View full text Add to dashboard Cite

Objective. To investigate whether high-flow nasal cannula (HFNC) oxygen therapy is superior to conventional oxygen therapy for reducing hypoxemia and postoperative pulmonary complications (PPC) in patients with thoracoscopic lobectomy after extubation. Methods. Patients with intermediate to high risk for PPC were enrolled in this study. Subjects were randomly assigned to HFNC group (HFNCG) or conventional oxygen group (COG) following extubation. Arterial blood samples were collected after extubation at 1, 2, 6, 12, 24, 48, and 72 h. Patients with postoperative hypoxemia and PPC were recorded. Adverse events were also documented. Results. Totally 110 patients were randomly assigned to HFNCG (n = 56) and COG (n = 54). The occurrence rate of hypoxemia in COG was twice more than that in HFNCG (29.62% versus 12.51%, P < 0.05) and PaO2, PaO2/FiO2, and SaO2/FiO2 were significantly improved in HFNCG (P < 0.05) in the first 72 h following extubation. Respiratory rate and incidence of reintubation as well as needing noninvasive ventilation were also decreased in HFNCG (P < 0.05), whereas the incidence of pneumonia and atelectasis were similar (P > 0.05). Adverse effects as throat and nasal pain occurred more frequently in COG. Conclusions. HFNC application improves oxygenation and reduces the risk of reintubation following thoracoscopic lobectomy but cannot decrease the incidence of PPC.

show abstract

Comparative evaluation of high-flow nasal cannula and conventional oxygen therapy in paediatric cardiac surgical patients: a randomized controlled trial

Abstract: HFNC had no impact on PaCO2 values. The use of HFNC appeared to be safe and improved PaO2 in paediatric cardiac surgical patients.

Cited by 81 publications

References 20 publications

Heated humidified high-flow nasal cannula therapy in children

Heated humidified high-flow nasal cannula therapy in children

Epidemiology of Noninvasive Ventilation in Pediatric Cardiac ICUs*

Effect of High-Flow Nasal Cannula versus Conventional Oxygen Therapy for Patients with Thoracoscopic Lobectomy after Extubation

Contact Info

Product

Resources

About