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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.

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.


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.


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).


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

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