Comparison of a high-flow humidified nasal cannula to nasal continuous positive airway pressure in children with acute bronchiolitis: experience in a pediatric intensive care unit

Metge, Prune; Grimaldi, Céline; Hassid, Sophie; Thomachot, Laurent; Loundou, Anderson; Martin, Claude; Michel, Fabrice

doi:10.1007/s00431-014-2275-9

Cited by 79 publications

(62 citation statements)

References 21 publications

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“…This is in opposition to Metge et al, who found no difference with respect to RR development [17]. On the contrary, Metge et al found, in concordance with our findings, a higher FiO2 in the HFNC group, although it did not reach significance.…”

Section: Discussioncontrasting

confidence: 58%

Comparison of CPAP and HFNC in Management of Bronchiolitis in Infants and Young Children

Pedersen

Vahlkvist

2017

Children

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Continuous positive airway pressure (CPAP) has been used in infants with bronchiolitis for decades. Recently, high flow nasal cannula (HFNC) therapy was introduced We conducted a retrospective study of treatment with CPAP vs. HFNC between 2013 and 2015, comparing the development in respiratory rate, fraction of inspired oxygen (FiO2) and heart rate, treatment failure, duration of treatment, and length of hospital stay. A sample size of 49 children were included. Median age was 1.9 months. Median baseline pCO2 was 7.4 kPa in both groups, respiratory rate per minute was 57 vs. 58 (CPAP vs. HFNC). Respiratory rate decreased faster in the CPAP group (p < 0.05). FiO2 decreased in the CPAP group and increased in the HFNC group during the first 12 h, whereafter it decreased in both groups. (p < 0.01). Heart rate development was similar in both groups. Twelve children (55%) changed systems from HFNC to CPAP due to disease progression. There was no difference in length of treatment, hospital stay, or transmission to intensive care unit between the groups. CPAP was more effective than HFNC in decreasing respiratory rate (RR) and FiO2. No differences were observed in length of treatment or complications. Further studies should be conducted to compare the efficacy of the two treatments of bronchiolitis, preferably through prospective randomized trials.

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Section: Discussioncontrasting

confidence: 58%

Comparison of CPAP and HFNC in Management of Bronchiolitis in Infants and Young Children

Pedersen

Vahlkvist

2017

Children

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“…However, leaks around the mask may cause discomfort and make it necessary to interrupt treatment. [12][13][14][15][16] A pediatric helmet has been used to deliver CPAP in neonates, infants, and preschool children with ARF. [17][18][19][20][21][22][23] In this population, CPAP by helmet was better tolerated than a facial mask, with no major complications and less need for sedation.…”

Section: Respiratory Syncytial Virus (Rsv)mentioning

confidence: 99%

Continuous Positive Airway Pressure With Helmet Versus Mask in Infants With Bronchiolitis: An RCT

et al. 2015

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BACKGROUND: Noninvasive continuous positive airway pressure (CPAP) is usually applied with a nasal or facial mask to treat mild acute respiratory failure (ARF) in infants. A pediatric helmet has now been introduced in clinical practice to deliver CPAP. This study compared treatment failure rates during CPAP delivered by helmet or facial mask in infants with respiratory syncytial virus-induced ARF. METHODS:In this multicenter randomized controlled trial, 30 infants with respiratory syncytial virus-induced ARF were randomized to receive CPAP by helmet (n = 17) or facial mask (n = 13). The primary endpoint was treatment failure rate (defined as due to intolerance or need for intubation). Secondary outcomes were CPAP application time, number of patients requiring sedation, and complications with each interface.RESULTS: Compared with the facial mask, CPAP by helmet had a lower treatment failure rate due to intolerance (3/17 [17%] vs 7/13 [54%], P = .009), and fewer infants required sedation (6/17 [35%] vs 13/13 [100%], P = .023); the intubation rates were similar. In successfully treated patients, CPAP resulted in better gas exchange and breathing pattern with both interfaces. No major complications due to the interfaces occurred, but CPAP by mask had higher rates of cutaneous sores and leaks.CONCLUSIONS: These findings confirm that CPAP delivered by helmet is better tolerated than CPAP delivered by facial mask and requires less sedation. In addition, it is safe to use and free from adverse events, even in a prolonged clinical setting. WHAT'S KNOWN ON THIS SUBJECT:In a previous short-term physiologic randomized controlled trial, continuous positive airway pressure by helmet was feasible and efficient in improving gas exchange in pediatric acute respiratory failure due to bronchiolitis. WHAT THIS STUDY ADDS:Continuous positive airway pressure administered by helmet reduces the rate of noninvasive respiratory support failure and provides longer application time with less sedation than a facial mask. In addition, it is safe to use and free from adverse events.

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“…15 In another study, data relating to 34 infants admitted to a PICU with bronchiolitis during two consecutive winters were retrospectively reviewed. 16 Nasal CPAP was used as first-line noninvasive respiratory support during the first winter and was replaced by HHHFNC (initial flow rate 1 L/kg/min, up to a maximum of 8 L/min) during the second winter. There was no statistically significant difference in physiological parameters (heart rate, respiratory rate, fraction of inspired oxygen (F i O 2 ) or partial pressure of carbon dioxide ( pCO 2 )) or length of PICU stay between the two groups.…”

Section: Role Of Hhhfnc Therapy In Bronchiolitismentioning

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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Comparison of a high-flow humidified nasal cannula to nasal continuous positive airway pressure in children with acute bronchiolitis: experience in a pediatric intensive care unit

Abstract: We did not find a difference between HFNC and nCPAP in the management of severe bronchiolitis in our PICU. Larger prospective studies are required to confirm these findings.

Cited by 79 publications

References 21 publications

Comparison of CPAP and HFNC in Management of Bronchiolitis in Infants and Young Children

Comparison of CPAP and HFNC in Management of Bronchiolitis in Infants and Young Children

Continuous Positive Airway Pressure With Helmet Versus Mask in Infants With Bronchiolitis: An RCT

Heated humidified high-flow nasal cannula therapy in children

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