Feasibility of high-flow nasal cannula implementation for children with acute lower respiratory tract disease in rural Kenya

Arnim, Amélie O. von Saint André-von; Okeyo, Bob; Cook, Nathan; Steere, Mardi; Roberts, Joan; Howard, Christopher R.; Stanberry, Larissa; John‐Stewart, Grace; Shirk, Arianna

doi:10.1080/20469047.2018.1536874

Cited by 8 publications

(6 citation statements)

References 12 publications

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“…Previously published data indicates that delays in diagnosis or management of hypoxemia due to pneumonia may be the main cause of these high rates in low-income countries (22,23). As expected NIV methods such as HHHFNC use are limited in these countries (23). Since our results indicate early and significant improvement in hypoxemia due to pneumonia, we can conclude that good outcomes are associated with HHFNC use.…”

Section: Discussionsupporting

confidence: 75%

“…As shown in meta-analysis, hypoxemia, which is defined with a cut-off for SpO 2 below 90%, is associated with significantly increased odds of death from acute lower respiratory infections (odds ratio: 5.47, 95%, confidence interval: 3.93 to 7.63) in children (21). Previously published data indicates that delays in diagnosis or management of hypoxemia due to pneumonia may be the main cause of these high rates in low-income countries (22,23). As expected NIV methods such as HHHFNC use are limited in these countries (23).…”

Section: Discussionmentioning

confidence: 99%

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The Effectiveness of Heated Humidified High-flow Nasal Cannula in Children with Severe Bacterial Pneumonia in the Emergency Department

Yurtseven¹,

Saz²

2020

jpr

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The provision of appropriate respiratory support has a great role in outcome of patients presenting to the emergency department (ED) with respiratory distress (RD) associated with severe pneumonia. In recent years, heated humidified high-flow nasal cannula (HHHFNC) therapy has become one of the most popular non-invasive respiratory support modalities in all pediatric settings. In this study, we aimed to assess whether the use of HHHFNC therapy is associated with reduced RD and improvements in hypoxemia among children with severe bacterial pneumonia (SBP) presenting to the ED. Materials and Methods: We performed a prospective observational study of patients with SBP admitted to a tertiary children's hospital pediatric ED who received HHHFNC therapy within the 2 year study period. The primary outcome was accepted as treatment failure (It was defined as a clinical escalation in respiratory status) and an increase in peripheral capillary oxygen saturation (SpO 2). Secondary outcomes covered a decrease of respiratory rate (RR), heart rate (HR), and rates of weaning, intubation and intensive care unit (ICU) admission. Results: Fifty-six patients were included in this analyses. Treatment failure was 21.5% (12/56). Among these patients, 9 (16%) were intubated and 3 (5.5%) placed on bilevel positive airway pressure. The mean initial RR values were significantly higher in the non responders group than the responder group (p=0.027). Significant variation in the intubation rate or the ICU admission rate was not determined. At the 2 nd hour, the fall in RR (p<0.001), HR (p<0.001), and the increase of SpO 2 (p<0.001) were significantly evident when compared with the beginning. Conclusion: HHHFNC therapy reached treatment success in a majority of the patients with SBP and provided an early effect. Patients with higher RRs responded less to HHHFNC. Further larger studies are needed to assess the impact of HHHFNC compared with other possible therapies.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

The Effectiveness of Heated Humidified High-flow Nasal Cannula in Children with Severe Bacterial Pneumonia in the Emergency Department

Yurtseven¹,

Saz²

2020

jpr

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“…Bedside providers in these settings have reported that providing HFNT is much easier than CPAP. 17 To date, HFNT has been successfully implemented in a variety of resource-limited settings 18,19 and there is an ongoing trial that is examining whether its use could reduce mortality in African children. 20 Respiratory disease was the second most common cause of PICU mortality in Instituto Nacional de Salud del Niño, a large Peruvian children's hospital, in 2016.…”

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confidence: 99%

Nasal high flow therapy introduction lowers reintubation risk in a Peruvian paediatric intensive care unit

et al. 2020

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Despite improvements in global child mortality, more than 650 000 children under five die of lower respiratory infections every year. 1 The vast majority of these deaths occur in low-and middle-income countries, due to more restricted access to basic interventions like immunisations, antibiotics and supplemental oxygen. 2-4 Middle-income countries have a high burden of paediatric respiratory disease. They are also in a unique position to reduce respiratory-related mortality, by improving access to advanced respiratory support, such as mechanical ventilation and non-invasive respiratory support. Using mechanical ventilation leads to complications like ventilator-associated pneumonia, ventilator-induced lung injuries, laryngeal trauma and the prolonged use of sedative medications. Given these complications, many

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“…Our search identified 1105 articles, with 2 additional articles identified on review of references. After duplicates were removed 902 references were screened, including full text review of 41 publications, of which 18 were excluded ( Figure 1 ): 9 because it was not possible to extract data specific to patients who received CPAP [ 12 - 24 ], 4 because it was not possible to extract data specific to post-neonatal patients [ 25 - 28 ], 3 because it was not possible to extract data specific to low and middle income countries [ 4 , 29 , 30 ], 1 because it was a pooled analysis which included studies in which most patients did not have pneumonia [ 31 ], and 1 because it was published prior to the year 2000 [ 32 ].…”

Section: Resultsmentioning

confidence: 99%

Continuous Positive Airway Pressure (CPAP) for severe pneumonia in low- and middle-income countries: A systematic review of contextual factors

et al. 2022

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Background Continuous positive airway pressure (CPAP) may have a role in reducing the high mortality in children less than 5 years with World Health Organization (WHO) severe pneumonia. More evidence is needed to understand important contextual factors that impact on implementation, effectiveness, and safety in low resource settings. Methods We conducted a systematic review of Medline, Embase and Pubmed (January 2000 to August 2020) with terms of “pneumonia”, “CPAP” and “child”. We included studies that provided original clinical or non-clinical data on the use of CPAP in children (28 days-4 years) with pneumonia in low- or middle-income countries. We used standardised tools to assess study quality, and grade levels of evidence for clinical conclusions. Results are presented as a narrative synthesis describing context, intervention, and population alongside outcome data. Results Of 902 identified unique references, 23 articles met inclusion criteria, including 6 randomised controlled trials, one cluster cross over trial, 12 observational studies, 3 case reports and 1 cost-effectiveness analysis. There was significant heterogeneity in patient population, with wide range in mortality among participants in different studies (0%-55%). Reporting of contextual factors, including staffing, costs, and details of supportive care was patchy and non-standardised. Current evidence suggests that CPAP has a role in the management of infants with bronchiolitis and as escalation therapy for children with pneumonia failing standard-flow oxygen therapy. However, CPAP must be implemented with appropriate staffing (including doctor oversight), intensive monitoring and supportive care, and technician and infrastructure capacity. We provide practical guidance and recommendations based on available evidence and published expert opinion, for the adoption of CPAP into routine care in low resource settings and for reporting of future CPAP studies. Conclusions CPAP is a safe intervention in settings that can provide intensive monitoring and supportive care, and the strongest evidence for a benefit of CPAP is in infants (aged less than 1 year) with bronchiolitis. The available published evidence and clinical experience can be used to help facilities assess appropriateness of implementing CPAP, guide health workers in refining selection of patients most likely to benefit from it, and provide a framework for components of safe and effective CPAP therapy. Protocol registration PROSPERO registration: CRD42020210597.

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Feasibility of high-flow nasal cannula implementation for children with acute lower respiratory tract disease in rural Kenya

Cited by 8 publications

References 12 publications

The Effectiveness of Heated Humidified High-flow Nasal Cannula in Children with Severe Bacterial Pneumonia in the Emergency Department

The Effectiveness of Heated Humidified High-flow Nasal Cannula in Children with Severe Bacterial Pneumonia in the Emergency Department

Nasal high flow therapy introduction lowers reintubation risk in a Peruvian paediatric intensive care unit

Continuous Positive Airway Pressure (CPAP) for severe pneumonia in low- and middle-income countries: A systematic review of contextual factors

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