High-flow nasal cannula therapy for infants with bronchiolitis

Beggs, Sean; Wong, Zee Hame; Kaul, S; Ogden, Kathryn; Walters, Julia

doi:10.1002/14651858.cd009609

Cited by 30 publications

(38 citation statements)

References 15 publications

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“…This was the only study to be included in a recent Cochrane review of the role of HHHFNC therapy in bronchiolitis which concluded that there was insufficient evidence for its effectiveness. 18 Several ongoing randomised controlled trials comparing HHHFNC therapy with standard oxygen therapy were identified and will be included in future updates. An Australian study comparing prospectively identified infants with bronchiolitis who received HHHFNC therapy with retrospectively identified controls (who received low-flow nasal oxygen therapy) found that the infants receiving HHHFNC therapy were four times less likely to require PICU admission (OR 4.09, p=0.043).…”

Section: Role Of Hhhfnc Therapy In Bronchiolitismentioning

confidence: 99%

Heated humidified high-flow nasal cannula therapy in children

2014

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Heated humidified high-flow nasal cannula therapy (HHHFNC) was originally described as a mode of respiratory support in premature neonates and is now increasingly used in the management of acute respiratory failure in older infants and children. Heating and humidification of gas mixtures allow comfortable delivery of flow rates that match or exceed the patient's inspiratory flow rate. Emerging evidence from observational studies suggests that the use of HHHFNC therapy may be associated with reduced work of breathing, improved ventilation efficiency and a decreased need for intubation in children with respiratory insufficiency. There are several proposed mechanisms of action, and the potential for provision of unpredictable positive distending pressure has caused concern. Randomised controlled trial evidence comparing clinical outcomes with those achieved using other forms of respiratory support is, however, awaited. We review the proposed mechanisms of actions, indications, advantages and complications of HHHFNC therapy in children and describe our approach to its use in the paediatric ward environment.

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Section: Role Of Hhhfnc Therapy In Bronchiolitismentioning

confidence: 99%

Heated humidified high-flow nasal cannula therapy in children

2014

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“…7,8 Four recent systematic reviews concluded that there was insufficient evidence supporting HFNC and highlighted a lack of randomized, controlled trials. 1,[9][10][11] In the only emergency department study of HFNC, a case series of 17 emergency department subjects were switched from standard O 2 to HFNC, with improvements shown in dyspnea scores, breathing frequency and oxygen saturations. 12 Patients with acute hypoxia and respiratory distress presenting to the emergency department may need noninvasive (NIV) or invasive positive-pressure ventilation requiring a high level of nursing care.…”

Section: Introductionmentioning

confidence: 99%

Randomized Controlled Trial of Humidified High-Flow Nasal Oxygen for Acute Respiratory Distress in the Emergency Department: The HOT-ER Study

Jones¹,

Kamona²,

Doran³

et al. 2015

Respir Care

138

117

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BACKGROUND: Humidified high-flow nasal cannula (HFNC) is a novel method of oxygen delivery with increasing use in emergency departments and intensive care settings despite little evidence showing benefit over standard oxygen delivery methods (standard O 2 ). The aim of this study was to determine whether HFNC compared with standard O 2 given to subjects in acute respiratory distress would reduce the need for noninvasive ventilation or invasive ventilation. METHODS: This was a pragmatic open randomized controlled trial in adult subjects with hypoxia and tachypnea presenting to a tertiary academic hospital emergency department. The primary outcome was the need for mechanical ventilation in the emergency department. RESULTS: We screened 1,287 patients, 322 met entry criteria and 19 were excluded from analysis. Of these, 165 randomized to HFNC and 138 to standard O 2 were analyzed. Baseline characteristics were similar. In the HFNC group, 3.6% (95% CI 1.5-7.9%) versus 7.2% (95% CI 3.8 -13%) in the standard O 2 group required mechanical ventilation in the emergency department (P ‫؍‬ .16), and 5.5% (95% CI 2.8 -10.2%) in HFNC versus 11.6% (95% CI 7.2-18.1%) in the standard O 2 group required mechanical ventilation within 24 h of admission (P ‫؍‬ .053). There was no difference in mortality or stay. Adverse effects were infrequent; however, fewer subjects in the HFNC group had a fall in Glasgow coma score due to CO 2 retention, 0% (95% CI 0 -3%) versus 2.2% (95% CI 0.4 -6%). One in 12 subjects did not tolerate HFNC. CONCLUSIONS: HFNC was not shown to reduce the need for mechanical ventilation in the emergency department for subjects with acute respiratory distress compared with standard O 2 , although it was safe and may reduce the need for escalation of oxygen therapy within the first 24 h of admission.

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“…HFNC was first introduced to prevent atelectasis and apneas in premature babies. Most of the studies in the pediatric literature suggest use in management of children younger than 24 months of age with moderately severe acute viral bronchiolitis, in whom HFNC may reduce the need for invasive respiratory support, thus potentially lowering costs with clinical advantages and minimal adverse events [1].…”

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confidence: 99%