DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20214851

Comparison of high flow oxygen therapy in children with respiratory distress due to bronchiolitis and pneumonia

Uday S. Surabhi, Gangasamudra Veerappa Basavaraja, Maaz Ahmed, Sujith Kumar Tummala

Abstract


Background: Respiratory support through high flow nasal cannula (HFNC) therapy has emerged as a new method to provide respiratory support with bronchiolitis. Aim was to study outcome of HFNC therapy in children with bronchiolitis and pneumonia.

Methods: The study was a prospective observational study involving children admitted to pediatric intensive care unit with respiratory distress (RD) in the age group of 1 month to 6 years over a period of 3 months (February 2017 till April 2017). Severity was assessed by clinical respiratory score (CRS). Children with RD were initiated with high flow nasal cannula. During treatment various parameters including CRS were documented at baseline and at 15 min and then hourly in a carefully designed performa. The primary outcome was failure of HFNC and need for ventilation.

Results: Sixty children were included in the study of which 22 (37%) were in the bronchiolitis group and 38 (63%) were in the pneumonia group. 38 children presented with severe RD and 19 children with moderate RD. There was significant decrease in heart rate (HR) (20%), respiratory rate (RR) (20%) and in CRS within 1 hour of HFNC with a clinical stabilization within 24 hours in 16 cases (27%), 24-48 hours in 35 cases (58%) and >48 hours in 5 (8%) cases. Therapy was successful in 55 (92%), and failed in 5 (8%).

Conclusions: HFNC has better outcome in children with RD due to acute bronchiolitis when compared to pneumonia. HFNC can be safely commenced in RD in critically ill child with monitoring.


Keywords


Bronchiolitis, High flow nasal cannula oxygen therapy, Pneumonia, Respiratory distress

Full Text:

PDF

References


Lee JH, Rehder KJ, Williford L, Cheifetz IM, Turner DA. Use of high flow nasal cannula in critically ill infants, children, and adults: a critical review of the literature. Intensive Care Med. 2013;39(2):247-57.

Pham TM, O'Malley L, Mayfield S, Martin S, Schibler A. The effect of high flow nasal cannula therapy on the work of breathing in infants with bronchiolitis. Pediatr Pulmonol. 2015;50(7):713-20.

Frat JP, Brugiere B, Ragot S, Chatellier D, Veinstein A, Goudet V, et al. Sequential application of oxygen therapy via high-flow nasal cannula and noninvasive ventilation in acute respiratory failure: an observational pilot study. Respir Care. 2015;60(2):170-8.

Roca O, Riera J, Torres F, Masclans JR. High-flow oxygen therapy in acute respiratory failure. Respir Care. 2010;55:408-13.

Lee JH, Rehder KJ, Williford L, Cheifetz IM, Turner D. Use of high fl ow nasal cannula in critically ill infants, children, and adults: a critical review of the literature. Intensive Care Med. 2012;39:247-57.

Milési C, Boubal M, Jacquot A, Baleine J, Durand S, Odena MP, et al. High-flow nasal cannula: recommendations for daily practice in pediatrics. Ann Intensive Care. 2014;4:29.

Wing R, James C, Maranda LS, Armsby CC. Use of high-flow nasal cannula support in the emergency department reduces the need for intubation in pediatric acute respiratory insufficiency. Pediatr Emerg Care. 2012; 28(11):1117-23.

Oto A, Erdoğan S, Boşnak M. Oxygen therapy via high flow nasal cannula in pediatric intensive care unit. Turkish J Pediatr. 2016;58:377-82.

Mayfield S, Bogossian F, O’Malley L, Schibler A. High-flow nasal cannula oxygen therapy for infants with bronchiolitis: Pilot study. J Paediatr Child Health. 2014;50:373-8.

Schibler A, Pham TM, Dunster KR, Foster K, Barlow A, Gibbons K, Hough JL. Reduced intubation rates for infants after introduction of high-flow nasal prong oxygen delivery. Intensive Care Med. 2011;37:847-52.

Keenan SP, Sinuff T, Cook DJ, Hill NS. Does noninvasive positive pressure ventilation improve outcome in acute hypoxemic respiratory failure? A systematic review. Crit Care Med. 2004;32(12):2516-23.