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Comparison of heated humidi?ed high-flow nasal cannula flow rates (1-L·kg·min-1 vs 2-L·kg·min -1 ) in the management of acute bronchiolitis.

ABSTRACT: OBJECTIVE:We aimed to compare the heated humidi?ed high-?ow nasal cannula (HHHFNC) flow rate of 1-L·kg·min-1 (1?L) with 2-L·kg·min -1 (2?L) in patients with severe bronchiolitis presenting to the pediatric emergency department. STUDY DESIGN:We performed a study in which all patients were allocated to receive these two flow rates. The primary outcome was admitted as treatment failure, which was defined as a clinical escalation in respiratory status. Secondary outcomes covered a decrease of respiratory rate (RR), heart rate (HR), the clinical respiratory score (CRS), rise of peripheral capillary oxygen saturation (SpO2 ), and rates of weaning, intubation, and intensive care unit (ICU) admission. RESULTS:One hundred and sixty-eight cases (88 received the 1-L flow rate and 80, the 2-L flow rate) were included in the analyses. Treatment failure was 11.4% (10 of 88) in the 1-L group, and 10% (8 of 80) in the 2-L group (P?=?.775). Significant variation in the intubation rate or the ICU admission rate was not determined. At the 2nd hour, the rate of weaning (53.4% vs 35%; P?=?.017), the falling down of the CRS (-2.1 vs -1.5; P?

SUBMITTER: Yurtseven A

PROVIDER: S-EPMC7167921 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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Comparison of heated humidiﬁed high-flow nasal cannula flow rates (1-L·kg·min<sup>-1</sup> vs 2-L·kg·min <sup>-1</sup> ) in the management of acute bronchiolitis.

Yurtseven Ali A Turan Caner C Erseven Eren E Saz Eylem Ulas EU Saz Eylem Ulas EU

Pediatric pulmonology 20190318 6

<h4>Objective</h4>We aimed to compare the heated humidiﬁed high-ﬂow nasal cannula (HHHFNC) flow rate of 1-L·kg·min<sup>-1</sup> (1 L) with 2-L·kg·min <sup>-1</sup> (2 L) in patients with severe bronchiolitis presenting to the pediatric emergency department.<h4>Study design</h4>We performed a study in which all patients were allocated to receive these two flow rates. The primary outcome was admitted as treatment failure, which was defined as a clinical escalation in respiratory status. Secondary ...[more]

PMID: 30887731

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Project description:ImportanceMost children's hospitals have adopted weight-based high-flow nasal cannula (HFNC) bronchiolitis protocols for use outside of the intensive care unit (ICU) setting. Whether these protocols are achieving their goal of reducing bronchiolitis-related ICU admissions remains unknown.ObjectiveTo measure the association between hospital transition to weight-based non-ICU HFNC use and subsequent ICU admission.Design, setting, and participantsThis multicenter retrospective cohort study was conducted with a controlled interrupted time series approach and involved 18 children's hospitals that contribute data to the Pediatric Health Information Systems database. The cohort included patients aged 0 to 24 months who were hospitalized with a diagnosis of bronchiolitis between January 1, 2010, and December 31, 2021. Data were analyzed from July 2023 to January 2024.ExposureHospital-level transition from ICU-only to weight-based non-ICU protocol for HFNC use. Data for the ICU-only group were obtained from a previously published survey.Main outcomes and measuresProportion of patients with bronchiolitis admitted to the ICU.ResultsA total of 86 046 patients with bronchiolitis received care from 10 hospitals in the ICU-only group (n = 47 336; 27 850 males [58.8%]; mean [SD] age, 7.6 [6.2] years) and 8 hospitals in the weight-based protocol group (n = 38 710; 22 845 males [59.0%]; mean [SD] age, 7.7 [6.3] years). Mean age and sex were similar for patients between the 2 groups. Hospitals in the ICU-only group vs the weight-based protocol group had higher proportions of Black (26.2% vs 19.8%) and non-Hispanic (81.6% vs 63.8%) patients and patients with governmental insurance (68.1% vs 65.9%). Hospital transition to a weight-based HFNC protocol was associated with a 6.1% (95% CI, 8.7%-3.4%) decrease per year in ICU admission and a 1.5% (95% CI, 2.8%-0.1%) reduction per year in noninvasive positive pressure ventilation use compared with the ICU-only group. No differences in mean length of stay or the proportion of patients who received invasive mechanical ventilation were found between groups.Conclusions and relevanceResults of this cohort study of hospitalized patients with bronchiolitis suggest that transition from ICU-only to weight-based non-ICU HFNC protocols is associated with reduced ICU admission rates.

Project description:ImportanceRespiratory distress syndrome and feeding intolerance are common conditions that are often associated with preterm infants. Showing similar efficacy, nasal continuous positive airway pressure (NCPAP) and heated humidified high-flow nasal cannula (HHHFNC) are the most widespread noninvasive respiratory support (NRS) in neonatal intensive care units, but their effect on feeding intolerance is unknown.ObjectiveTo evaluate the effect of NCPAP vs HHHFNC on high-risk preterm infants with respiratory distress syndrome.Design, setting, and participantsThis multicenter randomized clinical trial involved infants who were born in 1 of 13 neonatal intensive care units in Italy between November 1, 2018, and June 30, 2021. Preterm infants with a gestational age of 25 to 29 weeks, who were suitable for enteral feeding and who proved to be medically stable on NRS for at least 48 hours were enrolled in the study within the first week of life and randomized to receive either NCPAP or HHHFNC. Statistical analysis was performed according to the intention-to-treat approach.InterventionNCPAP or HHHFNC.Main outcomes and measuresThe primary outcome was the time to full enteral feeding (FEF), defined as an enteral intake of 150 mL/kg per day. Secondary outcomes were the median daily increment of enteral feeding, signs of feeding intolerance, effectiveness of the assigned NRS, peripheral oxygen saturation (SpO2)-fraction of inspired oxygen (FIO2) ratio at changes of NRS, and growth.ResultsTwo-hundred forty-seven infants (median [IQR] gestational age, 28 [27-29] weeks; 130 girls [52.6%]) were randomized to the NCPAP group (n = 122) or the HHHFNC group (n = 125). There were no differences in the primary and secondary nutritional outcomes between the 2 groups. The median time to reach FEF was 14 days (95% CI, 11-15 days) in the NCPAP group and 14 days (95% CI, 12-18 days) in the HHHFNC group, and similar results were observed in the subgroup of infants with less than 28 weeks' gestation. On the first NRS change, higher SpO2-FIO2 ratio (median [IQR], 4.6 [4.1-4.7] vs 3.7 [3.2-4.0]; P < .001) and lower rate of ineffectiveness (1 [4.8%] vs 17 [73.9%]; P < .001) were observed in the NCPAP vs HHHFNC group.Conclusions and relevanceThis randomized clinical trial found that NCPAP and HHHFNC had similar effects on feeding intolerance, despite different working mechanisms. Clinicians may tailor respiratory care by selecting and switching between the 2 NRS techniques on the basis of respiratory effectiveness and patient compliance, without affecting feeding intolerance.Trial registrationClinicalTrials.gov Identifier: NCT03548324.

Dataset Information

Comparison of heated humidi?ed high-flow nasal cannula flow rates (1-L·kg·min-1 vs 2-L·kg·min -1 ) in the management of acute bronchiolitis.

Publications

Comparison of heated humidiﬁed high-flow nasal cannula flow rates (1-L·kg·min<sup>-1</sup> vs 2-L·kg·min <sup>-1</sup> ) in the management of acute bronchiolitis.

Similar Datasets

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