First-line treatment using high-flow nasal cannula for children with severe bronchiolitis: Applicability and risk factors for failure

Guillot, Camille; Reun, C. Le; Behal, Hélène; Labreuche, Julien; Recher, Morgan; Duhamel, Alain; Leteurtre, Stéphane

doi:10.1016/j.arcped.2018.01.003

Cited by 45 publications

(38 citation statements)

References 27 publications

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“…However, some questions such as “which dose should be preferred for infants with bronchiolitis?” about this respiratory support modality still have not found an answer . Although previously the 1‐L·kg·min −1 flow rate or 4 to 8 L/min flow rate was frequently used in patients with bronchiolitis, currently most centers choose the 2‐L·kg·min −1 flow rate . But this modification is based on only a few physiological studies, and there still has been no satisfactory clinical data to determine the optimal flow rate required for clinical benefit …”

Section: Discussionmentioning

confidence: 99%

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

Yurtseven

Turan

Erseven

et al. 2019

Pediatric Pulmonology

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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.

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Section: Discussionmentioning

confidence: 99%

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

Yurtseven

Turan

Erseven

et al. 2019

Pediatric Pulmonology

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“…Milési et al found, in a randomized controlled trial (TRAMONTANE study), that initial management of moderate to severe bronchiolitis in patients admitted to the PICU with HFNC was inferior to CPAP in terms of failure rate. Guillot et al suggested that HFNC therapy for children with bronchiolitis can potentially decrease the use of nasal continuous positive airway pressure (nCPAP), and it can be used as the first line of management in the PICU. Other smaller population studies have also compared with the use of HFNC for bronchiolitis with CPAP.…”

Section: Introductionmentioning

confidence: 99%

“…Based on the absence of significant differences in the vital signs and oxygen requirements at the inclusion time, this might reflect that severity of the bronchiolitis was likely similar between the three groups.There are limited studies in the literature that have compared HFNC with the other noninvasive ventilation (NIV) modalities (CPAP or BiPAP) in infants and children with bronchiolitis in terms of failure rate and morbidity or mortality outcomes in patients who need PICU admission. A recent publication17 concluded that the use of HFNC might actually decrease the need for other noninvasive respiratory support such as CPAP and BiPAP, when used as the first respiratory support modality. This study assigned patients to either HFNC or CPAP/BiPAP (this was based on physician's discretion in the first phase of the study) and showed similar failure rates when comparing HFNC with other NIV modalities.…”

mentioning

confidence: 99%

A comparison between high‐flow nasal cannula and noninvasive ventilation in the management of infants and young children with acute bronchiolitis in the PICU

Habra

Janahi

Dauleh

et al. 2020

Pediatric Pulmonology

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Background Different modalities of noninvasive respiratory support have been recommended for the management of acute bronchiolitis in the pediatric intensive care unit (PICU). High‐flow nasal cannula (HFNC) is among the new modalities that have been widely used in the last decade. Methods This is a retrospective study involving infants and young children between the ages of 1 month and 2 years during the respiratory season of 2016‐2017 (October‐May). We compared the failure rate of HFNC with the failure rates of bi‐level positive airway pressure (BiPAP) vs continuous positive airway pressure (CPAP) in the management of acute bronchiolitis in the PICU. Failure was defined as a change to another respiratory support modality or endotracheal intubation and mechanical ventilation. Results One hundred thirty‐seven patients met the inclusion criteria, of which 77 patients needed HFNC, 10 needed CPAP, and 50 were on BiPAP. Among baseline characteristics, there were significant variations in age among the three groups. HFNC had a higher failure rate compared with the other two noninvasive ventilation modalities (50.6% for HFNC [n = 39 out of 77] vs 0% for CPAP [n = 0 out of 10] vs 8% for BiPAP [n = 4 out of 50], P < .01). Among the 39 patients who failed HFNC, 90% were successfully shifted to BiPAP and weaned off later, whereas the other 4 were intubated and required mechanical ventilation. However, all four patients who failed BiPAP were intubated and mechanically ventilated. No respiratory complications or mortalities were reported in the three groups. No differences were observed among the three groups in terms of the lengths of PICU or hospital stays. Conclusions We observed a higher failure rate of HFNC compared with BiPAP or CPAP in the management of infants and children with acute bronchiolitis in the PICU. Further prospective randomized trials are recommended to confirm this finding.

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“…Similarly, a French retrospective review over two seasons noted that the use of HFOT increased from 34 to 90% of PICU admissions (displacing nCPAP and bilevel over this time period), but the intubation rate remained stable at 10% (n ¼ 4) versus 5% (n ¼ 3). 9 Many other hospitals provide HFOT in ward areas, restricting critical care for children with more severe disease who are not responding. As HFOT is likely to remain a support modality in both ward and critical care areas for the future, methods to record organizational preferences to enable intersite comparison should be established.…”

Section: Organizational Aspectsmentioning

confidence: 99%

“…In a multivariate analysis of factors associated with intubation, an increase in pCO 2 was the only significant parameter in one study. 9 In summary, critical care for bronchiolitis demonstrates organizational and cultural variances which can be difficult to capture consistently across reports. Better methods of identifying these factors are required.…”

Section: Clinical Aspectsmentioning

confidence: 99%

Critical Care Thresholds in Children with Bronchiolitis

Cunningham

2020

Am J Perinatol

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Reduction in mortality from bronchiolitis in developed health is principally achieved from the availability of critical care. Different health care providers and countries demonstrate considerable variance in admission rates, but globally the use and cost of this resource are increasing. The reasons of this are multifold and include organizational, cultural, and clinical aspects. The organization of care has evolved differently in different health care settings at the threshold of critical need, with local priorities and resources determining the location of care (ward or critical care). Critical care areas adopting high-flow oxygen therapy (HFOT) (a ward-based therapy in some institutions) have seen significant increase in their occupancy, without change in rates of mechanical ventilation. Culturally, some countries appear to have a lower threshold for intubation and mechanical ventilation: United States (18%), Finland (4%), and even in countries with high rates of critical care admission (27% in Australia and New Zealand), intubation rates can decline with time (reducing from 27% to 11%). Baseline clinical characteristics of children admitted to critical care are remarkably similar, children are young (c30–60 days) and often born prematurely (21–46%). Clinical thresholds for admission as predefined by critical care units in online guidance focus on presence of apnea (observed in 7–42% of admissions), low pulse oxygen saturation and subjective measures (exhaustion and reduced consciousness). Clinical characteristics of children at the time of admission are commonly reported in relation to the modified Woods Clinical Asthma Score (mean = 3.8 to ≥7) and raised pCO2 (range = 8.0–8.8 kPa), with pCO2 the only significant parameter in a multivariate analysis of factors associated with intubation. Key Points

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First-line treatment using high-flow nasal cannula for children with severe bronchiolitis: Applicability and risk factors for failure

Cited by 45 publications

References 27 publications

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

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

A comparison between high‐flow nasal cannula and noninvasive ventilation in the management of infants and young children with acute bronchiolitis in the PICU

Critical Care Thresholds in Children with Bronchiolitis

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First-line treatment using high-flow nasal cannula for children with severe bronchiolitis: Applicability and risk factors for failure

Cited by 45 publications

References 27 publications

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

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

A comparison between high‐flow nasal cannula and noninvasive ventilation in the management of infants and young children with acute bronchiolitis in the PICU

Critical Care Thresholds in Children with Bronchiolitis

Contact Info

Product

Resources

About

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

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