Article

3 Iconography
Access to the text (HTML) Access to the text (HTML)
PDF Access to the PDF text
Advertising


Access to the full text of this article requires a subscription.
  • If you are a subscriber, please sign in 'My Account' at the top right of the screen.

  • If you want to subscribe to this journal, see our rates

  • You can purchase this item in Pay Per ViewPay per View - FAQ : 30,00 € Taxes included to order
    Pages Iconography Videos Other
    6 3 0 0


Archives de pédiatrie
Volume 25, n° 3
pages 213-218 (avril 2018)
Doi : 10.1016/j.arcped.2018.01.003
Received : 14 June 2017 ;  accepted : 14 January 2018
Research Papers

First-line treatment using high-flow nasal cannula for children with severe bronchiolitis: Applicability and risk factors for failure
 

C. Guillot a, , C. Le Reun a, H. Behal b, c, J. Labreuche b, c, M. Recher a, A. Duhamel b, c, S. Leteurtre a, c
a Pediatric Intensive Care Unit, CHRU de Lille, 59000 Lille, France 
b Department of Biostatistics, CHRU de Lille, 59000 Lille, France 
c EA 2694, santé publique: épidémiologie et qualité des soins, université de Lille, CHRU de Lille, 59000 Lille, France 

Corresponding author. Service de réanimation et de surveillance continue pédiatrique, hôpital Jeanne-de-Flandre, avenue Avinée, CHRU de Lille, 59037 Lille cedex, France.Service de réanimation et de surveillance continue pédiatrique, hôpital Jeanne-de-Flandre, avenue Avinée, CHRU de Lille, 59037 Lille cedex, France.
Abstract
Background

Viral bronchiolitis is the leading cause of hospitalization in children during the first 12 months of life. There is evidence to support the use of noninvasive ventilation in bronchiolitis. A recent respiratory management of bronchiolitis is the use of high-flow nasal cannula (HFNC) therapy. The primary objective of this study was to evaluate the use of HFNC as the first-line treatment for children with severe bronchiolitis and the secondary objective was to identify factors for HFNC therapy failure.

Methods

Observational prospective study in a pediatric intensive care unit (PICU), during two consecutive seasons (2013–2014 without recommendation and 2014–2015 with a study design suggesting HFNC as first-line treatment). The percentages of children treated with HFNC, nasal continuous or biphasic positive airway pressure (nCPAP/BiPAP) and invasive ventilation were compared. Associations between parameters recorded and HFCN therapy failure were established.

Results

The percentage of patients treated with HFNC at admission was higher during the second season (90%, n =55/61) than the first season (34%, n =14/41) (p <0.0001). In bivariate analysis, heart rate, pH, and pCO2 were significantly associated with the occurrence of HFNC therapy failure in time-varying Cox regression models using all available values (i.e., admission and repeated measures during the first 5 days of hospitalization). Only pCO2 remained independently associated as a factor of HFNC failure in the multivariate Cox model with a hazard ratio per 5mmHg of 1.37 (95%CI: 1.01–1.87; P =0.046).

Conclusion

In our PICU, HFNC therapy for children with bronchiolitis can potentially decrease the use of nCPAP. In this study, the factor of failure was higher pCO2 . Studies to evaluate PCO2 level to discriminate HFNC versus CPAP indication could be useful.

The full text of this article is available in PDF format.

Keywords : Bronchiolitis, Continuous positive airway pressure, High-flow nasal cannula, Children, Respiratory therapy




© 2018  Elsevier Masson SAS. All Rights Reserved.
EM-CONSULTE.COM is registrered at the CNIL, déclaration n° 1286925.
As per the Law relating to information storage and personal integrity, you have the right to oppose (art 26 of that law), access (art 34 of that law) and rectify (art 36 of that law) your personal data. You may thus request that your data, should it be inaccurate, incomplete, unclear, outdated, not be used or stored, be corrected, clarified, updated or deleted.
Personal information regarding our website's visitors, including their identity, is confidential.
The owners of this website hereby guarantee to respect the legal confidentiality conditions, applicable in France, and not to disclose this data to third parties.
Close
Article Outline