Amaç: Bu çalışmanın amacı, alt solunum yolu enfeksiyonu nedeniyle solunum sıkıntısı yaşayan ve yüksek akım oksijen tedavisi alan pediatrik hastalarda sürüntü pozitifliği, eşlik eden kronik hastalık ve prematüritenin tedaviye yanıta etkisini araştırmaktır. Gereç ve yöntem: Çalışmaya 1 ay ile 9 yaş arasında solunum sıkıntısı nedeniyle acil servisimize başvuran, alt solunum yolu enfeksiyonu tanısı alan ve yüksek akımlı nazal kanül oksijen tedavisi uygulanan çocuk hastalar dahil edildi. Hasta kayıtları geriye dönük olarak incelendi. Hastaların demografik verileri gözden geçirildi. Hastalar nazofarengeal sürüntü pozitifliğine göre pozitif ve negatif olanlar olarak gruplandırıldı. Solunum sıkıntısına neden olan hastalıklar ve enfeksiyon etkeninin, eşlik eden kronik hastalık varlığının ve erken doğum öyküsünün tedaviye yanıta etkisi araştırıldı. Bulgular: Nazofarengeal sürüntü pozitifliğinin, yüksek akımlı nazal kanül oksijen tedavisi uygulama süresi üzerinde önemli bir etkiye sahip olduğu, ancak ventilatöre bağlanma ihtiyacını ortadan kaldırmada etkisiz olduğu bulundu. Kronik hastalık varlığında tedaviye yanıtın anlamlı oranda azaldığı tespit edildi. Sonuç: Eşlik eden kronik hastalık varlığı, tedaviye cevapsızlıkta etkili en önemli faktör olarak bulundu. Kronik hastalığı olanlarda invaziv solunum destek cihazı uygulamasına hazırlıklı olunmalıdır.
Objective: The aim of this study is to investigate the effect of swab positivity, concomitant chronic disease, and prematurity on response to treatment in pediatric patients with respiratory distress due to lower respiratory tract infection and receiving high flow oxygen therapy. Materials and method: Pediatric patients admitted to our emergency department due to respiratory distress aged between 1 month and 9 years, who were diagnosed with lower respiratory tract infection and were treated with high flow nasal cannula oxygen therapy were included in this study. Patient records were scanned retrospectively. Demographic data of the patients were reviewed. The patients were grouped as positive and negative ones according to nasopharyngeal swab positivity. The effects of diseases that cause respiratory distress, infectious agent, presence of concomitant chronic diseases, and history of preterm birth on response to treatment were investigated. Results: It was found that nasopharyngeal swab positivity had a significant effect on the duration of high flow nasal cannula oxygen therapy administration, but it was ineffective in eliminating the need to connect to a ventilator. It was found that the response to treatment was significantly reduced in the presence of chronic disease. Conclusions: The presence of chronic concomitant disease was found to be the most important factor in treatment unresponsiveness. For patients with chronic diseases, be prepared for invasive respiratory support.
1. Meissner HC. Viral bronchiolitis in children. N Engl J Med 2016;374; 62-72.
2. Duke T, Wandi F, Jonathan M, Matai S, Kaupa M, Saavu M, et al. Improved oxygen systems for childhood pneumonia: a multihospital effectiveness study in Papua New Guinea. Lancet 2008;372:1328-33.
3. Ralston SL, Lieberthal AS, Meissner HC, Alverson BK, Baley JE, Gadomski AM, et al. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics 2014;134:e1474-502.
4. Long E, Babl FE, Duke T. Is there a role for humidified heated highflow nasal cannula therapy in paediatric emergency departments? Emerg Med J 2016; 33: 386-9.
5. Parke RL, Eccleston ML, Mc Guinness SP. The effects of flow on airway pressure during nasal high-flow oxygen therapy. Respir Care 2011;56:1151-5.
6. 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):713-720.
7. Mayfield S, Jauncey-Cooke J, Hough JL, Schibler A, Gibbons K, Bogossian F. High-flow nasal cannula therapy for respiratory support in children. Cochrane Database Syst Rev. 2014;2014(3):CD009850.
8. Milési C, Boubal M, Jacquot A, Balaine J, Durand S, Odena MP, Camboine G. Hihg flow nasal cannula: recommendations for Daily practice in pediatrics. Annals of Intansive Care 2014;4(1):29.
9. Lopez-Fermandez Y, Azagra AM, de la Olive P, Modesto V, Sanchez JI, Parrilla J, et al. Pediatric acute lung ınjury epidemiology and natural history study:incidence and outcome of the acute respiratory distres ssyndrome in children. Crit Care Med. 2012;40:3238-45.
10. 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;28:1117-23.
11. Franklin D, Babl FE, Schlapbach LJ, et al. A randomized trial of highflow oxygen therapy in infants with bronchiolitis. N Engl J Med. 2018;378(12):1121-1131. doi:10.1056/NEJMoa 1714855.
12. Kelly GS, Simon HK, Sturm JJ. High-flow nasal cannula use in children with respiratory distress in the emergency department:predicting the need for subsequent intubation. Pediatr Emerg Care. 2013;29:888-92.
13. Milani GP, Plebani AM, Arturi E, Brusa D, Esposito S, Dell’Era L, et al. Using a high flow nasal cannule provided superior results to low flow oxygen delivery in moderateto severe bronchiolitis. Acta Paedatr. 2016;105:e368-72. Ulviye KIRLI ve Ark. Ulviye KIRLI et.al.
14. Mayfield S, Bogassian 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.
15. Vareesunthorn I, Preutthipan A. Modified high-flow nasal cannula in young children with pneumonia: A 3-year retrospective study. Pediatr Respirol Crit Care Med 2018;2:45-50.
16. Yurtseven A, Saz E. U. The Effectiveness of heated humidified high-flow nasal cannula in children with severe bacterial pneumonia in the emergency department. Journal of Pediatric Research 2019; 7, 1-7.
17. Frat JP, Thille AW, Mercat A, Girault C, Ragot S, Perbet S, et al.; FLORALI Study Group; REVA Network. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med2015;372:2185-2196.
18. Geoghegan S, Erviti A, Caballero MT, Vallone F, Zanone SM, Losada JV, et al. Mortality due to respiratory syncytial virus. Burden and risk factors. Am J Respir Crit Care Med.2017;195:96-103.
19. De Conto F, Conversano F, Medici MC, et al. Epidemiology of human respiratory viruses in children with acute respiratory tract infection in a 3- year hospital-based survey in Northern Italy. Diagn Microbiol Infect Dis. 2019;94(3):260-267
20. Working Group of the Clinical Practice Guideline on Acute Bronchiolitis. Quality plan for the Spanish national health care system of the Spanish Ministry for Health and Social Policy; Catalan Agency for Health Technology Assessment; 2010. Clinical Practice Guidelines in the Spanish National Health care System:CAHTA no. 2007/05.
21. Mahony JB. Nucleic acid amplification-based diagnosis of respiratory virüs infections. Expert Rev Anti Infect Ther. 2010;8 (11):1273-1292.
22. Nair H, Nokes DJ, Gessner BD, Dherani M, Madhi SA, Singleton RJ, et al. Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis. Lancet. 2010;375:1545-55.2.
23. Glezen WP, Taber LH, Frank AL, Kasel JA. Risk of primary infection and reinfection with respiratory syncytial virus. Am J Dis Child. 1986;140:543-6.
24. Byington CL, Wilkes J, Korgenski K, Sheng X. Respiratory syncytial virusassociated mortality in hospitalized infants and young children. Pediatrics. 2015;135:e24-31.
25. American Academy of Pediatrics Committee on Infectious D, American Academy of Pediatrics. Bronchiolitis Guidelines C. Updated guidance for palivizumab prophylaxis among infants and young children at increased risk of hospitalization for respiratory syncytial virüs infection. Pediatrics. 2014;134:e620-38.17