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J Paediatr Child Health. 2014 May;50(5):373-8. doi: 10.1111/jpc.12509. Epub 2014 Feb 25.

High-flow nasal cannula oxygen therapy for infants with bronchiolitis: pilot study.

Author information

1
Paediatric Critical Care Research Group, PICU, Mater Children's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, The University of Queensland, Brisbane, Queensland, Australia.

Abstract

AIM:

To obtain data on the safety and clinical impact of managing infants with bronchiolitis on the ward with high-flow nasal cannula (HFNC) treatment.

METHODS:

A prospective pilot study was conducted of 61 infants aged <12 months with bronchiolitis and oxygen requirement presenting to the emergency department. HFNC was commenced at 2 L/kg/min, and fraction of inspired oxygen was titrated to oxygen saturation > 94%. A standard-treatment group (n = 33) managed with standard low-flow subnasal oxygen during the same time period was retrospectively identified.

RESULTS:

Admission demographics, heart rate (HR) and respiratory rate (RR) were similar in test and standard-treatment groups. Responders and non-responders to HFNC were identified within 60 min of treatment. Non-responders to HFNC requiring paediatric intensive care unit (PICU) admission showed no change in HR and RR, whereas responders showed decreases in HR and RR (P < 0.02). Patients receiving HFNC were four times less likely to need PICU admission than the standard treatment group (OR 4.086, 95%CI 1.0-8.2; P = 0.043). No adverse events such as pneumothorax, bradycardia, bradypnoea, emergency intubation or cardiopulmonary resuscitation were observed. No patients admitted to the PICU required intubation.

CONCLUSIONS:

HFNC treatment in the paediatric ward is safe. Non-responders requiring PICU admission can be identified within the first hour of HFNC treatment by monitoring HR and RR. It is feasible to undertake a randomised controlled trial based on this pilot with the aim of decreasing PICU admissions.

KEYWORDS:

bronchiolitis; high-flow nasal cannula; infant

PMID:
24612137
DOI:
10.1111/jpc.12509
[Indexed for MEDLINE]

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