Baudin Florent, Gagnon Sebastien, Crulli Benjamin, Proulx François, Jouvet Philippe, Emeriaud Guillaume
Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada. Pediatric Intensive Care Unit, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Bron, France.
Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada.
Respir Care. 2016 Oct;61(10):1305-10. doi: 10.4187/respcare.04452. Epub 2016 Aug 2.
High-flow nasal cannula (HFNC) therapy is increasingly used in pediatric ICUs as an intermediate level of support between conventional oxygen delivery and noninvasive ventilation (NIV). The safety of HFNC has seldom been studied, and some cases of barotrauma have been reported. This retrospective study aims to describe HFNC use in a tertiary care pediatric ICU, with a focus on the complications associated with this therapy.
Between January 2013 and January 2014, all children <18 y old treated with HFNC in the pediatric ICU were included. Demographic data, HFNC settings, chest radiograph reports, and blood gas values were gathered from the electronic medical records. Episodes of pneumothorax, pneumomediastinum, and significant epistaxis were noted. Pneumothorax was distinguished from chest tube-related air leak (frequent after cardiac surgery), which was defined as a small pneumothorax with no clinical impact that resolved spontaneously after chest tube removal.
During the 1-y study period, there were 177 HFNC episodes, involving 145 subjects with a median (interquartile range) age of 8 (2-28) months. HFNC was used as primary support in 31% of episodes, after extubation in 36% and after NIV in 18%. HFNC was administered exclusively for nitric oxide delivery in 16% of episodes. Two children (1%) developed new pneumothoraces that required chest tube insertion, whereas 5 (3%) chest tube-related air leaks were noted. One (0.6%) episode of significant epistaxis was noted. Among 6 preexisting pneumothoraces, none worsened under HFNC. Failure of HFNC occurred in 32 episodes, requiring transition to NIV in 28 cases and endotracheal intubation in 5 cases.
Support with HFNC following a clinical protocol in pediatric ICUs was associated with a relatively low rate of complications. Since HFNC use is increasing, further evidence is needed to confirm its efficacy and safety.
高流量鼻导管（HFNC）治疗在儿科重症监护病房（PICU）中越来越多地被用作传统氧疗和无创通气（NIV）之间的一种中级支持方式。HFNC的安全性很少被研究，且已有一些气压伤病例的报道。这项回顾性研究旨在描述一家三级医疗儿科重症监护病房中HFNC的使用情况，重点关注与该治疗相关的并发症。
纳入2013年1月至2014年1月期间在儿科重症监护病房接受HFNC治疗的所有18岁以下儿童。从电子病历中收集人口统计学数据、HFNC设置、胸部X光片报告和血气值。记录气胸、纵隔气肿和严重鼻出血的发作情况。气胸与胸管相关的空气泄漏（心脏手术后常见）相区分，胸管相关的空气泄漏定义为小气胸，对临床无影响，在拔除胸管后自行缓解。
在为期1年的研究期间，共发生177次HFNC治疗，涉及145名受试者，中位（四分位间距）年龄为8（2 - 28）个月。31%的治疗中HFNC被用作主要支持方式，36%在拔管后使用，18%在无创通气后使用。16%的治疗中HFNC专门用于一氧化氮输送。两名儿童（1%）出现了需要插入胸管的新气胸，而发现5例（3%）胸管相关的空气泄漏。记录到1例（0.6%）严重鼻出血。在6例既往存在的气胸中，无一例在HFNC治疗下恶化。32次HFNC治疗失败，其中28例需要转为无创通气，5例需要气管插管。
在儿科重症监护病房按照临床方案使用HFNC，并发症发生率相对较低。由于HFNC的使用正在增加，需要进一步的证据来证实其疗效和安全性。
