Impact of High-Flow Nasal Cannula on Respiratory Distress in Pediatric Intensive Care
CCCF ePoster library. Kawaguchi A. Oct 28, 2015; 117305; P
Dr. Atsushi Kawaguchi
Dr. Atsushi Kawaguchi
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Abstract
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Topic: Retrospective or Prospective Cohort Study


Impact of High-Flow Nasal Cannula on Respiratory Distress in Pediatric Intensive Care



Atsushi Kawaguchi, Y. Yasui, D. Garros

, Stollery Children’s Hopsital, University of Alberta, Edmonton, Canada | School of Public Health, University of Alberta, Edmonton, Canada | Pediatric Critical Care Medicine, Stollery Children’s Hopsital, University of Alberta, Edmonton, Canada

Introduction:

High-Flow Nasal Cannula (HFNC) for non-invasive respiratory support has been recently recognized as a support option for critically ill children with respiratory distress due to a variety of etiologies. However, evidence regarding the effectiveness of HFNC in this population is limited and therefore the clinical impact of HFNC is still unclear.1-5)



Objectives:

In this study, we assessed the impact of the introduction of HFNC as a support modality on the outcomes of critically ill children with symptoms of respiratory distress in a pediatric intensive care unit (PICU).



Methods:

All patients aged 0 to 17 years admitted with respiratory distress to a PICU in a Canadian quaternary children’s hospital, between 2004 and 2014 were included. We initially assessed differences in clinical outcomes between the pre-HFNC era (2004-08) and the post-HFNC era (2010-14), excluding 2009 as a washout period, using an interrupted time series (ITS) analysis with a propensity-score adjustment. We then conducted a matched-pair analysis using the use of HFNC as an exposure of interest, adjusting for the same set of variables as the ITS analysis. In both analyses, PICU length of stay and total invasive ventilation days were used as primary outcomes analyzed by linear regression; the need for endotracheal intubation during the PICU stay was used as a secondary outcome analyzed by Poisson regression. We matched a HFNC case with a patient without this support modality according to age, body weight, pediatric risk of mortality score (PRISM) III, and referring area (emergency department, general ward, or operational room).



Results:

A total of 1,770 children met the inclusion criteria (pre-HFNC era: 702 cases; post-HFNC era: 1,068 cases), the majority of whom were unplanned emergency admissions (pre- HFNC era: 668;, post-HFNC era:1,023 cases). Approximately half of the patients were diagnosed as a pneumonia or bronchiolitis at the PICU admissions (pre-HFNC era: 344 cases; post-HFNC era: 489 cases). HFNC was utilized in 455 cases (42.6%) in the post-HFNC era. The ITS analysis showed no statistically significant difference in the length of stay in the PICU, but shortened invasive ventilation by 2.4 days in the post-HFNC era [95% Confidence Interval (CI): 0.2 to 4.5, P=0.030]. The proportion of patients with PICU intubation in the post-HFNC era was 0.71 times of that in the pre-HFNC era [95%CI: 0.62 to 0.83, P<0.001]. A total of 450 pairs were formed for the matched-pair analysis. While no statistically significant difference was seen in the total invasive ventilation days, the length of stay in the PICU increased statistically significantly by 3.0 days with HFNC use [95%CI: 1.3 to 4.7, P=0.001]. As expected, the endotracheal intubation in the patients for whom HFNC were used decreased; the proportion patients with the intubation was 0.79 [95%CI: 0.56 to 1.13, P=0.19] times in cases who utilized HFNC for less than 72 hours and 0.29 [0.21-0.39, p<0.001] times in those over 8 days, as compared to those who did not.



Conclusion:

We found that the overall endotracheal intubation rate in PICU was reduced by utilizing HFNC for patients with respiratory distress independently of its cause. Significant reduction of the total invasive ventilation days was also achieved by the introduction of HFNC as a support modality for respiratory distress in PICU. However, this study also suggests that HFNC could increase the overall length of stay in the PICU.




References: 1. Lee JH, Rehder KJ, Williford L, Cheifetz IM, Turner DA. Use of high flow nasal cannula in critically ill infants, children, and adults: a critical review of the literature. Intensive care medicine. 2013;39(2):247-57.
2. Beggs S, Wong ZH, Kaul S, Ogden KJ, Walters JA. High-flow nasal cannula therapy for infants with bronchiolitis. The Cochrane database of systematic reviews. 2014;1:CD009609.
3. Mayfield S, Jauncey-Cooke J, Hough JL, Schibler A, Gibbons K, Bogossian F. High-flow nasal cannula therapy for respiratory support in children. The Cochrane database of systematic reviews. 2014;3:CD009850.
4. Collins CL, Holberton JR, Barfield C, Davis PG. A randomized controlled trial to compare heated humidified high-flow nasal cannulae with nasal continuous positive airway pressure postextubation in premature infants. The Journal of pediatrics. 2013;162(5):949-54 e1.
5. Schlapbach LJ, Schaefer J, Brady AM, Mayfield S, Schibler A. High-flow nasal cannula (HFNC) support in interhospital transport of critically ill children. Intensive care medicine. 2014;40(4):592-9.
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