Predictive factors of high-flow nasal cannula oxygen therapy failure in children with respiratory distress treated in a Pediatric Emergency Department
Background. High-flow nasal cannula (HFNC) is widely used as a feasible and tolerable respiratory support method. However, patients should be closely monitored, especially when used with moderate-severe respiratory distress indications. Because these patients can easily develop respiratory failure and escalated care may be required. The aim of this study is to determine the predictive factors in patients treated with HFNC who received escalated respiratory support for HFNC failure. Methods. A retrospective study of patients admitted with respiratory distress and treated with HFNC therapy between January 2014 and December 2018 was carried out. The variables evaluated were age, gender, vital signs before and two hours post HFNC therapy, underlying disease, use of steroid, salbutamol and antibiotic therapy, blood gase analysis and lactate values, hospitalization in pediatric intensive care unit, respiratory viral panel and need for escalation of respiratory support. HFNC failure was identified requiring noninvasive or invasive respiratory support despite HFNC therapy. Results. 243 patients receiving HFNC therapy were included in this study. The median age was 11 months [interquartile range(IQR) 5–27]. The diagnosis of 183 patients (75.3%) were acute bronchiolitis and 60 patients (24.7%) were pneumonia. Of 243 patients, 29 (%11.9) received escalated care. 22 invasive and 7 non-invasive respiratory supports were provided. The lower pH on admission was found in the non-responder group. Moreover, heart rate and respiratory rate did not decrease two hours after HFNC therapy. Conclusions. The careful monitoring of patients receiving HFNC therapy is critical. Because these patients are at risk for needing escalated care. We found that low pH values on admission and high pulse rate and respiratory rate observed at the second hour of follow-up period could be predictive factors for HFNC failure
___
1. Miller JD, Carlo WA. Pulmonary complications of mechanical ventilation in neonates. Clin Perinatol 2008; 35: 273-281. https://doi.org/10.1016/j. clp.2007.11.0042. de Winter JP, de Vries MA, Zimmermann LJ. Clinical practice: noninvasive respiratory support in newborns. Eur J Pediatr 2010; 169: 777-782. https:// doi.org/10.1007/s00431-010-1159-x
3. 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: 1117-1123. https://doi. org/10.1097/PEC.0b013e31827122a9
4. Kubicka ZJ, Limauro J, Darnall RA. Heated, humidified high-flow nasal cannula therapy: yet another way to deliver continuous positive airway pressure? Pediatrics 2008; 121: 82-88. https://doi. org/10.1542/peds.2007-0957
5. Arora B, Mahajan P, Zidan MA, Sethuraman U. Nasopharyngeal airway pressures in bronchiolitis patients treated with high-flow nasal cannula oxygen therapy. Pediatr Emerg Care 2012; 28: 1179- 1184. https://doi.org/10.1097/PEC.0b013e318271a671
6. Kwon JW. High-flow nasal cannula oxygen therapy in children: a clinical review. Clin Exp Pediatr 2020; 63: 3-7. https://doi.org/10.3345/kjp.2019.00626
7. 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: 888-892. https://doi.org/10.1097/ PEC.0b013e31829e7f2f
8. Lewis L, Fernandes R, Kapitein B, et al. Predicting failure of high flow nasal cannula in bronchiolitis: a systematic review. Eur Respir J 2019; 54: PA1005. https://doi.org/10.1183/13993003.congress-2019. PA1005
9. Kleinman ME, Chameides L, Schexnayder SM, et al. Part 14: pediatric advanced life support: 2010 American Heart Association Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2010; 122(18 Suppl3): S876-S908. https://doi.org/10.1161/ CIRCULATIONAHA.110.971085
10. O’Brien S, Craig S, Babl FE, Borland ML, Oakley E, Dalziel SR; Paediatric Research in Emergency Departments International Collaborative (PREDICT) Network, Australasia. ‘Rational use of high-flow therapy in infants with bronchiolitis. What do the latest trials tell us?’A Paediatric Research in Emergency Departments International Collaborative perspective. J Paediatr Child Health 2019; 55: 746- 752. https://doi.org/10.1111/jpc.14496
11. Deanehan JK, Nagler J. Respiratory distress. In: Hoffman RJ, Wang VJ, Scarfone RJ, Godambe SA, Pitetti R, (eds). Fleisher and Ludwig’s 5-Minute Pediatric Emergency Medicine Consult (1st ed). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2012. p. 812-813.
12. Ralston SL, Lieberthal AS, Meissner HC, et al; American Academy of Pediatrics. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics 2014; 134: e1474-e1502. https://doi.org/10.1542/peds.2014-2742
13. Harris M, Clark J, Coote N, et al; British Thoracic Society Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011. Thorax 2011; 66(Suppl 2): ii1-ii23. https://doi. org/10.1136/thoraxjnl-2011-200598
14. Schlapbach LJ, Straney L, Gelbart B, et al; Australian & New Zealand Intensive Care Society (ANZICS) Centre for Outcomes & Resource Evaluation (CORE) and the Australian & New Zealand Intensive Care Society (ANZICS) Paediatric Study Group. Burden of disease and change in practice in critically ill infants with bronchiolitis. Eur Respir J 2017; 49: 1601648. https://doi.org/10.1183/13993003.01648- 20
15. Essouri S, Laurent M, Chevret L, et al. Improved clinical and economic outcomes in severe bronchiolitis with pre-emptive nCPAP ventilatory strategy. Intensive Care Med 2014; 40: 84-91. https:// doi.org/10.1007/s00134-013-3129-z
16. Lazner MR, Basu AP, Klonin H. Non-invasive ventilation for severe bronchiolitis: analysis and evidence. Pediatr Pulmonol 2012; 47: 909-916. https://doi.org/10.1002/ppul.22513
17. Hough JL, Pham TM, Schibler A. Physiologic effect of high-flow nasal cannula in infants with bronchiolitis. Pediatr Crit Care Med 2014; 15: e214-e219. https:// doi.org/10.1097/PCC.0000000000000112
18. Milési C, Baleine J, Matecki S, et al. Is treatment with a high flow nasal cannula effective in acute viral bronchiolitis? A physiologic study. Intensive Care Med 2013; 39: 1088-1094. https://doi.org/10.1007/ s00134-013-2879-y
19. 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: 713-720. https://doi. org/10.1002/ppul.23060
20. Schibler A, Pham TM, Dunster KR, et al. Reduced intubation rates for infants after introduction of high-flow nasal prong oxygen delivery. Intensive Care Med 2011; 37: 847-852. https://doi.org/10.1007/ s00134-011-2177-5
21. Ganu SS, Gautam A, Wilkins B, Egan J. Increase in use of non-invasive ventilation for infants with severe bronchiolitis is associated with decline in intubation rates over a decade. Intensive Care Med 2012; 38: 1177-1183. https://doi.org/10.1007/s00134- 012-2566-4
22. McKiernan C, Chua LC, Visintainer PF, Allen H. High flow nasal cannulae therapy in infants with bronchiolitis. J Pediatr 2010; 156: 634-638. https://doi. org/10.1016/j.jpeds.2009.10.039
23. Er A, Çağlar A, Akgül F, et al. Early predictors of unresponsiveness to high-flow nasal cannula therapy in a pediatric emergency department. Pediatr Pulmonol 2018; 53: 809-815. https://doi. org/10.1002/ppul.23981
24. Franklin D, Babl FE, Schlapbach LJ, et al. A randomized trial of high-flow oxygen therapy in infants with bronchiolitis. N Engl J Med 2018; 378: 1121-1131. https://doi.org/10.1056/NEJMoa1714855
25. Kepreotes E, Whitehead B, Attia J, et al. High-flow warm humidified oxygen versus standard low-flow nasal cannula oxygen for moderate bronchiolitis (HFWHO RCT): an open, phase 4, randomised controlled trial. Lancet 2017; 389: 930-939. https:// doi.org/10.1016/S0140-6736(17)30061-2
26. Betters KA, Gillespie SE, Miller J, Kotzbauer D, Hebbar KB. High flow nasal cannula use outside of the ICU; factors associated with failure. Pediatr Pulmonol 2017; 52: 806-812. https://doi.org/10.1002/ ppul.23626
27. Davison M, Watson M, Wockner L, Kinnear F. Paediatric high-flow nasal cannula therapy in children with bronchiolitis: a retrospective safety and efficacy study in a nontertiary environment. Emerg Med Australas 2017; 29: 198-203. https://doi. org/10.1111/1742-6723.12741
28. 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: 373-378. https://doi.org/10.1111/ jpc.12509
29. Abboud PA, Roth PJ, Skiles CL, Stolfi A, Rowin ME. Predictors of failure in infants with viral bronchiolitis treated with high-flow, high-humidity nasal cannula therapy. Pediatr Crit Care Med 2012; 13: e343-e349. https://doi.org/10.1097/PCC.0b013e31825b546f
30. Chamberlain JM, Patel KM, Pollack MM. The pediatric risk of hospital admission score: a second- generation severity-of-illness score for pediatric emergency patients. Pediatrics 2005; 115: 388-395. https://doi.org/10.1542/peds.2004-0586
31. Duncan H, Hutchison J, Parshuram CS. The pediatric early warning system score: a severity of illness score to predict urgent medical need in hospitalized children. J Crit Care 2006; 21: 271-278. https://doi. org/10.1016/j.jcrc.2006.06.007
32. Ducharme FM, Chalut D, Plotnick L, et al. The Pediatric Respiratory Assessment Measure: a valid clinical score for assessing acute asthma severity from toddlers to teenagers. J Pediatr 2008; 152: 476- 480.e1. https://doi.org/10.1016/j.jpeds.2007.08.034
33. Hansen G, Hochman J, Garner M, Dmytrowich J, Holt T. Pediatric early warning score and deteriorating ward patients on high-flow therapy. Pediatr Int 2019; 61: 278-283. https://doi.org/10.1111/ ped.13787
34. Hegde S, Prodhan P. Serious air leak syndrome complicating high-flow nasal cannula therapy: a report of 3 cases. Pediatrics 2013; 131: e939-e944. https://doi.org/10.1542/peds.2011-376
- ISSN: 0041-4301
- Yayın Aralığı: Yılda 6 Sayı
- Başlangıç: 1958
- Yayıncı: Hacettepe Üniversitesi Çocuk Sağlığı Enstitüsü Müdürlüğü
Sayıdaki Diğer Makaleler
The relationship between immature platelet fraction and severity of acute bronchiolitis
Murat DOĞAN, Mehmet KÖSE, Mehmet Adnan ÖZTÜRK, Melih HANGÜL, Hümeyra ASLANER
Serdar GÜL, Cemile SÖNMEZ, Gökçe AYVAZ, Selçuk KILIÇ
Parental knowledge about familial Mediterranean fever: a cross-sectional study
Deniz Gezgin YILDIRIM, Sevcan A. BAKKALOĞLU, A. Şebnem SOYSAL ACAR, Necla BUYAN
The rare reason of pain in hip girdle: Mucolipidosis type 3 gamma
Abdulkerim KOLKIRAN, Beren KARAOSMANOĞLU, Zihni Ekim TAŞKIRAN, Pelin Özlem ŞİMŞEK KİPER, Gülen Eda UTİNE
Short and long term side effect of colistin treatment in preterm infants
Sadık YURTTUTAN, Burcu Cantay ATALAY
Allergic reactions during childhood vaccination and management
Elif Soyak AYTEKİN, Bülent E. ŞEKEREL, Ümit M. ŞAHİNER
Yeter DÜZENLİ KAR, Zeynep Canan ÖZDEMİR, Özcan BÖR
Evaluation of medication errors in pediatric patients using antibiotics
Nesligül ÖZDEMİR, Emre KARA, Ayşe BÜYÜKÇAM, Kübra AYKAÇ, Ayçe ÇELİKER, Kutay DEMİRKAN, Ateş KARA
Mitochondrial trifunctional protein deficiency as a polyneuropathy etiology in childhood
Özlem Ünal UZUN, Büşra ÇAVDARLI, Selen KARALÖK
Yeter Düzenli KAR, Zeynep Canan ÖZDEMİR, Kürşat Bora ÇARMAN, Coşkun YARAR, Neslihan TEKİN, Özcan BÖR