Comparison of heated humidified high‐flow nasal cannula flow rates (1‐L·kg·min⁻¹ vs 2‐L·kg·min⁻¹) in the management of acute bronchiolitis

Abstract

Objective We aimed to compare the heated humidified high‐flow nasal cannula (HHHFNC) flow rate of 1‐L·kg·min−1 (1 L) with 2‐L·kg·min −1 (2 L) in patients with severe bronchiolitis presenting to the pediatric emergency department. Study design We performed a study in which all patients were allocated to receive these two flow rates. The primary outcome was admitted as treatment failure, which was defined as a clinical escalation in respiratory status. Secondary outcomes covered a decrease of respiratory rate (RR), heart rate (HR), the clinical respiratory score (CRS), rise of peripheral capillary oxygen saturation (SpO2), and rates of weaning, intubation, and intensive care unit (ICU) admission. Results One hundred and sixty‐eight cases (88 received the 1‐L flow rate and 80, the 2‐L flow rate) were included in the analyses. Treatment failure was 11.4% (10 of 88) in the 1‐L group, and 10% (8 of 80) in the 2‐L group (P = .775). Significant variation in the intubation rate or the ICU admission rate was not determined. At the 2nd hour, the rate of weaning (53.4% vs 35%; P = .017), the falling down of the CRS (−2.1 vs −1.5; P < .001), RR (−15.2 vs −11.8; P < .001), and HR (− 24.8 vs − 21.2; P < .001), and the increase of SpO 2 (4.8 vs 3.6; P < .001) were significantly more evident in the 1‐L group. Conclusion HHHFNC with the 1‐L·kg·min−1 flow rate, which provides a more frequent earlier effect, reached therapy success as high as the 2‐L·kg·min −1 flow rate in patients with severe acute bronchiolitis.

Safety and Efficacy of High-flow Nasal Cannula Therapy in the Pediatric Emergency Department

“…Study design, outcome and key results are summarized in Table 1. Seven studies included only children with bronchiolitis [16][17][18][19][20][21][22] , six studies had children with respiratory distress due to any disease [23][24][25][26][27][28] and one study was on children with acute asthma exacerbations. 29 Five studies enrolled children up to 24 months of age 19,20,22,24,27 , four enrolled children up to 18 years of age 23,25,26,28 , four included children up to 12 months of age only [16][17][18]21 , and one enrolled children aged 1 to 14 years.…”

“…Seven studies included only children with bronchiolitis [16][17][18][19][20][21][22] , six studies had children with respiratory distress due to any disease [23][24][25][26][27][28] and one study was on children with acute asthma exacerbations. 29 Five studies enrolled children up to 24 months of age 19,20,22,24,27 , four enrolled children up to 18 years of age 23,25,26,28 , four included children up to 12 months of age only [16][17][18]21 , and one enrolled children aged 1 to 14 years. 29 In five studies, HFNC devices were used with 2 L/kg/min flow rate for infants or children up to 10 kg 17,21,25,28,29 , five studies did not report a specific flow rate 18,20,24,26,27 , in one study, 1 L/ kg/min flow rate was utilized 19 and in one study, both 1 L/kg/ min flow rate and 2 L/kg/min were used.…”

“…29 In five studies, HFNC devices were used with 2 L/kg/min flow rate for infants or children up to 10 kg 17,21,25,28,29 , five studies did not report a specific flow rate 18,20,24,26,27 , in one study, 1 L/ kg/min flow rate was utilized 19 and in one study, both 1 L/kg/ min flow rate and 2 L/kg/min were used. 22 In another study a flow rate of 1-8 L/min was used 16 , and in the last study a flow rate of 4-10 L/min was used for children younger than 24 months of age and 5-50 L/min flow rates in older children. 23 Four studies compared HFNC to standard oxygen therapy 18,19,21,29 , three evaluated reasons for HFNC therapy failure 24,25,28 , and two studies evaluated the effects of HFNC on intubation and PICU admission rates.…”

“…17,19,21 Although, some physiological studies reported that a flow rate ≥2 L/kg/min was required to achieve optimal effects, clinical studies have not supported this data. 15,22,38,40 Moreover, it has been indicated that a flow ≥2 L/kg/min was associated with a higher rate of discomfort and with a longer stay in the PICU. 15 In other age-based studies; while Long et al 25 have used 2 L/kg/min HFNC flow rate for the first 10 kg, then 0.5 L/kg/min for every kilogram thereafter, Er et al 28 have chosen 2 L/kg/min for infants and 1 L/kg/min for older children.…”

“…27 In other studies, it has been found that there was a significant reduction in RR and HR with HFNC therapy. 20,22 HFNC treatment achieved wide popularity especially with reports showing to reduce the rate of intubation and PICU admission. Most previous studies reported that the overall rate of intubation and PICU admission declined in patients with bronchiolitis by HFNC therapy.…”