High Flow Nasal Cannula Therapy for Bronchiolitis Across the Emergency Department and Acute Care Floor

Kline, Jaclyn N; Kalburgi, Sonal; Halley, Tina

doi:10.1016/j.cpem.2018.02.001

Cited by 10 publications

(11 citation statements)

References 30 publications

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“…possibility is that the widespread adoption of HFNC may be associated with observed trends as ward-based HFNC protocols have been associated with increased ICU use. [21][22][23][24] Its use may also justify the diagnosis of respiratory failure and may be associated with increased SOI index scores. As such, increasing HFNC use could explain both increasing costs and apparent increasing patient acuity.…”

Section: Discussionmentioning

confidence: 99%

“…It is not clear why resource use and apparent illness severity are increasing despite stable or improving patient outcomes. One possibility is that the widespread adoption of HFNC may be associated with observed trends as ward-based HFNC protocols have been associated with increased ICU use . Its use may also justify the diagnosis of respiratory failure and may be associated with increased SOI index scores.…”

Section: Discussionmentioning

confidence: 99%

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Trends in Hospital Costs and Levels of Services Provided for Children With Bronchiolitis Treated in Children’s Hospitals

et al. 2021

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IMPORTANCE Increasing hospital costs for bronchiolitis have been associated with increasing patient complexity and mechanical ventilation. However, the associations of illness severity and diagnostic coding practices with bronchiolitis hospitalization costs have not been examined. OBJECTIVETo investigate the association of patient complexity, illness severity, and diagnostic coding practices with bronchiolitis hospitalization costs. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cross-sectional study included 385 883 infants aged 24 months or younger who were hospitalized with bronchiolitis at 39 hospitals in the

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Trends in Hospital Costs and Levels of Services Provided for Children With Bronchiolitis Treated in Children’s Hospitals

et al. 2021

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“…The burden of bronchiolitis is relevant for pediatric emergency departments, resulting in overcrowding, economic impact, and an annual spike in the need for respiratory support. In this setting, the use of high-flow nasal cannula (HFNC) has spread worldwide in the past decade [3].…”

Section: Introductionmentioning

confidence: 99%

Increased use of high-flow nasal cannulas after the pandemic in bronchiolitis: a more severe disease or a changed physician’s attitude?

et al. 2022

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After the SARS-CoV-2 pandemic, we noticed a marked increase in high-flow nasal cannula use for bronchiolitis. This study aims to report the percentage of children treated with high-flow nasal cannula (HFNC) in various seasons. The secondary outcomes were admissions for bronchiolitis, virological results, hospital burden, and NICU/PICU need. We conducted a retrospective study in four Italian hospitals, examining the medical records of all infants (< 12 months) hospitalized for bronchiolitis in the last four winter seasons (1 September–31 March 2018–2022). In the 2021–2022 winter season, 66% of admitted children received HFNC versus 23%, 38%, and 35% in the previous 3 years. A total of 876 patients were hospitalized in the study periods. In 2021–2022, 300 infants were hospitalized for bronchiolitis, 22 in 2020–2021, 259 in 2019–2020, and 295 in 2018–2019. The percentage of patients needing intensive care varied from 28.7% to 18%, 22%, and 15% in each of the four considered periods (p < 0.05). Seventy-seven percent of children received oxygen in the 2021–2022 winter; vs 50%, 63%, and 55% (p < 0.01) in the previous 3 years. NIV/CPAP was used in 23%, 9%, 16%, and 12%, respectively. In 2021–2020, 2% of patients were intubated; 0 in 2020–2021, 3% in 2019–2020, and 1% in 2018–2019.Conclusion: This study shows a marked increase in respiratory support and intensive care admissions this last winter. While these severity indexes were all driven by medical choices, more reliable indexes such as intubation rate and length of stay did not change. Therefore, we suggest that there is a more aggressive treatment attitude rather than a more severe disease. What is Known:• COVID-19 pandemic deeply impacted bronchiolitis epidemiology, reducing hospitalizations to onetenth. In the 2021-2022 winter, bronchiolitis resurged to pre-pandemic numbers in Europe. What is New:• Bronchiolitis hospitalization rose much faster in the 2021-2022 winter period, peaking at a higher level. Respiratory supports and high-flow nasal cannula increased significantly compared to the pre-pandemic era.

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“…3 Actualmente, esta técnica se está utilizando progresivamente en todos los grupos de edades pediátricas, y cada vez más aceptada por sus efectos positivos sobre la oxigenación, la ventilación y la comodidad del paciente. [4][5][6][7][8][9][10][11] La mayoría de los estudios de la terapia con CNAF han sido realizados en neonatos o en el periodo de postextubación en lactantes con bronquiolitis 12 . Cada vez hay más estudios en población pediátrica que reportan que el uso de la CNAF es un tratamiento eficaz para la insuficiencia respiratoria aguda 4,5,[13][14][15] .…”

Section: Introductionunclassified

Eficacia de la Cánula Nasal de Alto Flujo en patologías respiratorias

Caparó¹,

Antonio²,

Dutari³

et al. 2021

Pediatr Panama

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Introducción: En la edad pediátrica hay factores predisponentes importantes que hacen a los niños ser más vulnerables a presentar insuficiencia respiratoria aguda (IRA). Objetivo: Demostrar los beneficios del uso de la cánula nasal de alto flujo (CNAF) en pacientes menores de 5 años con IRA secundaria a enfermedades respiratorias y admitidos a la unidad de cuidados intensivos pediátricos (UCIP). Sujetos y Métodos: Estudio analítico observacional de cohortes mixtas, donde una cohorte esta formada por un grupo expuesto a la CNAF evaluada de manera prospectiva, mientras se comparo con una cohorte histórica. Resultados: 138 pacientes fueron admitidos al estudio de los cuales 69 fueron casos manejados con CNAF y 69 fueron controles que no estuvieron expuestos al uso de la CNAF pero sí a otros modos de ventilación mecánica invasiva. Los días de oxigenoterapia fueron estadísticamente menores en el grupo de casos de 13 (DE 8.01) días a 22 (DE 20.7) días en el grupo control (P = <0.05). Al igual los días de UCIP y los días totales de hospitalización fueron menores en el grupo manejado con CNAF (P = 0.011 y P = 0.001, respectivamente), con una media de tiempo de 10 (DE 7.8) días en UCIP y 17 (DE 9.25) días intrahospitalarios para el grupo de casos versus 14 (DE 10.1) días en UCIP y 28 (DE 23.9) días intrahospitalarios para el grupo control. Conclusión: La CNAF es un método de soporte respiratorio no invasivo, efectivo y fácil de usar en la población pediátrica con IRA secundario a diversas patologías respiratorias.

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High Flow Nasal Cannula Therapy for Bronchiolitis Across the Emergency Department and Acute Care Floor

Cited by 10 publications

References 30 publications

Trends in Hospital Costs and Levels of Services Provided for Children With Bronchiolitis Treated in Children’s Hospitals

Trends in Hospital Costs and Levels of Services Provided for Children With Bronchiolitis Treated in Children’s Hospitals

Increased use of high-flow nasal cannulas after the pandemic in bronchiolitis: a more severe disease or a changed physician’s attitude?

Eficacia de la Cánula Nasal de Alto Flujo en patologías respiratorias

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