Efficacy of High-Flow Nasal Cannula vs Standard Oxygen Therapy or Nasal Continuous Positive Airway Pressure in Children with Respiratory Distress: A Meta-Analysis

Luo, Jian; Duke, Trevor; Chisti, Mohammod Jobayer; Kepreotes, Elizabeth; Kalinowski, Valerie; Li, Jie

doi:10.1016/j.jpeds.2019.07.059

Cited by 59 publications

(57 citation statements)

References 34 publications

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“…α � 0.05 and β � 0.20 were set. Based on response rates for control patients and HFNC cases reported in a previous study [19,21] and unpublished data obtained in our center describing the failure rate of conventional oxygenation therapy, we estimated at least a total of 34 subjects with an expected reactive rate of 95% in the HFNC group and 55% (95% * [1− 0.4] � 57%; a 40% reduction) in the control group (confidence level [1− α] � 95% and power level[1− β] � 80%).…”

Section: Discussionmentioning

confidence: 99%

High-Flow Nasal Cannula: A Promising Oxygen Therapy for Patients with Severe Bronchial Asthma Complicated with Respiratory Failure

Geng

Batu

You

et al. 2020

Canadian Respiratory Journal

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Severe bronchial asthma complicated with respiratory failure, a common critical illness in respiratory medicine, may be lifethreatening. High-flow nasal cannula (HFNC) is a novel oxygen therapy technique developed in recent years. HFNC was applied in this study for treating adult patients with severe bronchial asthma complicated with respiratory failure. Its efficacy was analyzed comparatively to conventional oxygen therapy (COT). HFNC and COT were randomly performed based on conventional treatment. e HFNC group was similar to COT-treated patients in terms of response rate, with no significant difference in efficacy between the two groups. In patients with bronchial asthma, effectively increased PO 2 and reduced PCO 2 were observed after treatment in both groups. However, HFNC was more efficient than COT in elevating PO 2 in patients with severe bronchial asthma complicated with respiratory failure, while no statistically significant difference in PCO 2 reduction was found between the two groups. Heart rate (HR) and respiratory rate (RR) between the two groups on admission (0 h) and at 2, 8, 24, and 48 h after admission were compared. Both indicators significantly decreased with time. No significant differences in HR and RR were found between the groups at 0, 2, and 8 h after admission. However, these indicators were significantly lower in the HFNC group compared with the COT group at 24 and 48 h after admission. HFNC could significantly elevate PO 2 and reduce HR and RR. us, it is a promising option for patients with severe bronchial asthma complicated with respiratory failure.

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Section: Discussionmentioning

confidence: 99%

High-Flow Nasal Cannula: A Promising Oxygen Therapy for Patients with Severe Bronchial Asthma Complicated with Respiratory Failure

Geng

Batu

You

et al. 2020

Canadian Respiratory Journal

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“…In this study, we only investigated a limited number of concentrations utilized with unit‐dose or infusion pump administration of albuterol, with one representative pediatric breathing profile, which was determined based on the summarization from our meta‐analysis on randomized controlled trials using pediatric HFNC (Supporting Information file).…”

Section: Discussionmentioning

confidence: 99%

In vitro comparison of unit dose vs infusion pump administration of albuterol via high‐flow nasal cannula in toddlers

Fink

2019

Pediatric Pulmonology

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Objectives Transnasal pulmonary aerosol delivery using high‐flow nasal cannula (HFNC) devices has become a popular route of aerosol administration in toddlers. Clinically, albuterol is administered using an infusion pump or unit doses. However, little evidence is available to compare the two administration strategies. Methods A toddler manikin (15 kg) with appropriate anatomic airway was connected with collecting filter to a simulator of distressed breathing. HFNC device with mesh nebulizer placed at the inlet of a humidifier at 37°C, with the gas flow set at 25 and 3.75 L/min. Five milligrams of albuterol was delivered in all experiments. With infusion pump administration, albuterol concentrations of 5 and 1 mg/mL were delivered at 4 and 20 mL/hr for 15 minutes. With unit dose administration, 1 mL (5 mg/mL) and 2 mL (2.5 mg/mL) of albuterol were nebulized. Additional tests with mouth open and nebulizers via mask were using 5 mg/1 mL for mesh nebulizer and 5 mg/3 mL for jet nebulizer (n = 3). The drug was eluted from the filter and assayed with UV spectrophotometry (276 nm). Results The inhaled dose was higher with unit dose than infusion pump administration with gas flows of 25 L/min (2.66 ± 0.38 vs 1.16 ± 0.28%; P = .004) and 3.75 L/min (10.51 ± 1.29 vs 8.58 ± 0.68%; P = .025). During unit dose administration, compared with closed‐mouth breathing, open‐mouth breathing generated a higher inhaled dose at 3.75 L/min and lower inhaled dose at 25 L/min. Compared to the nebulizers via mask with both open and closed‐mouth breathing, nebulization via HFNC at 3.75 L/min generated greater inhaled dose, while HFNC at 25 L/min generated lower inhaled dose. Conclusions During transnasal aerosol delivery, the inhaled dose was higher with medication administrated using unit dose than using an infusion pump.

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“…general information about the respondents, 2. their wards and their patients' characteristics including their primary illnesses, 3. information about the use of HHFNC in practice including responses to two case scenarios, comparison with both low flow oxygen therapy (LF) and CPAP.…”

Section: Methodsmentioning

confidence: 99%

“…Heated Humidified High Flow Nasal Cannula Oxygen Therapy (HHFNC) has become increasingly popular as an option for non-invasive respiratory support of infants and children in critical care. [1] More recently, HHFNC has also been introduced into paediatric wards in the United Kingdom (UK), mainly for the management of bronchiolitis, [2] and although high-quality evidence has begun to emerge on the clinical effectiveness of HHFNC compared to standard low flow oxygen therapy, [3] other trials that compared it with CPAP were primarily bronchiolitis-focused [4] with debatable interpretations. [5,6] The current use of HHFNC in infants and children, therefore, is still largely based on individual experience with a clear lack of national and international guidance.…”

Section: Introductionmentioning

confidence: 99%

A nationwide survey on the use of Heated Humidified High Flow Oxygen therapy on the paediatric wards in the UK: Current practice and research priorities

Hosheh

Edwards

Ramnarayan

2020

Preprint

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Background: Heated Humidified High Flow Nasal Cannula Oxygen Therapy (HHFNC) is increasingly used on the paediatric wards and High Dependency Units (HDU) for different types of pathologies and different age groups. We aimed to describe current practice related to the use of HHFNC on the paediatric wards and HDUs, weaning practices and preferred outcome measures for future research. Methods: We carried out a cross-sectional online survey of UK paediatric consultants or their delegates working on the paediatric wards. Descriptive analysis of their geographical, and organizational characteristics, their specialties, and their level of experience was investigated. Reasons for HHFNC initiation, weaning criteria, patients’ characteristics and their primary pathologies were also analysed. Results: Participation of 218 paediatricians from 81 hospitals (Median: 2.7, Range: 1-11) was registered. HHFNC was provided in most of the surveyed hospitals (93%, 75/81). A High Dependency Unit (HDU) was available in 47 hospitals (58%); less than a third of those have a dedicated paediatrician. Decisions around HHFNC were made solely by paediatricians in (75%) of the cases, mostly at hospitals with no HDU compared to those with dedicated HDUs (70.3% VS 36.6%, 95%CI:22.6%-50.4%, P< .001). Sixty-eight percent of the respondents agreed that HHFNC is either the same or superior to CPAP (Continuous Positive Airway Pressure) with fewer complications. Failure rate while on HHFNC was identified as the most important outcome measure in any future research followed by the length of need for HHFNC support (37.1%, and 28% respectively). Conclusion: This survey showed support for developing paediatric-specific national guidance on the use of HHFNC on the wards. Our list of defined research priorities may help guide further collaborative research efforts in this field.

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Efficacy of High-Flow Nasal Cannula vs Standard Oxygen Therapy or Nasal Continuous Positive Airway Pressure in Children with Respiratory Distress: A Meta-Analysis

Cited by 59 publications

References 34 publications

High-Flow Nasal Cannula: A Promising Oxygen Therapy for Patients with Severe Bronchial Asthma Complicated with Respiratory Failure

High-Flow Nasal Cannula: A Promising Oxygen Therapy for Patients with Severe Bronchial Asthma Complicated with Respiratory Failure

In vitro comparison of unit dose vs infusion pump administration of albuterol via high‐flow nasal cannula in toddlers

A nationwide survey on the use of Heated Humidified High Flow Oxygen therapy on the paediatric wards in the UK: Current practice and research priorities

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