Betters Kristina A, Gillespie Scott E, Miller Judson, Kotzbauer David, Hebbar Kiran B
Emory University, Atlanta, Georgia.
Children's Healthcare of Atlanta, Atlanta, Georgia.
Pediatr Pulmonol. 2017 Jun;52(6):806-812. doi: 10.1002/ppul.23626. Epub 2016 Nov 21.
High flow nasal cannula (HFNC) use is increasing in pediatrics. Few studies exist examining the safety of HFNC use outside the intensive care unit (ICU). This study aimed to characterize patient qualities associated with failure of HFNC use outside the ICU.
A retrospective chart review of patients placed on HFNC outside the ICU from September 2011 to July 2013 was completed. Failure was defined as intubation or cardiopulmonary arrest. Two-sample tests and binary logistic regression determined significant factors associated with failed HFNC administration, both unadjusted and adjusted for hospital.
Two hundred thirty-one patients met inclusion criteria, with 192 receiving treatment for a primary respiratory diagnosis (83%). Fourteen (6%) progressed to HFNC failure; 12 transferred to the ICU and were intubated, two with congenital heart disease suffered cardiopulmonary arrest on the floor. Two-sample tests revealed failure patients were more likely to have a cardiac history (P = 0.026), history of intubation (P = 0.040), and require higher fraction of inspired oxygen (FiO ) (median 100%; 25th-75th 60-100%; P = <0.001). Hospital adjusted logistic regression further demonstrated failure patients were more likely to be treated with higher FiO (OR: 38.3; 95% CI: 4.0-366.3; P = 0.002), and less likely to have a diagnosis of bronchiolitis (OR: 0.3; 95% CI: 0.1-0.9; P = 0.048).
High FiO requirements, history of intubation, and cardiac co-morbidity are associative predictors of HFNC failure. Bronchiolitis patients may be treated with HFNC outside of the ICU with lower odds of failure. Pediatr Pulmonol. 2017;52:806-812. © 2017 Wiley Periodicals, Inc.
儿科领域高流量鼻导管（HFNC）的使用正在增加。很少有研究探讨在重症监护病房（ICU）以外使用HFNC的安全性。本研究旨在描述与ICU以外HFNC使用失败相关的患者特征。
对2011年9月至2013年7月在ICU以外接受HFNC治疗的患者进行回顾性病历审查。失败定义为插管或心肺骤停。双样本检验和二元逻辑回归确定了与HFNC给药失败相关的显著因素，包括未调整的和针对医院进行调整的因素。
231名患者符合纳入标准，其中192名接受原发性呼吸诊断治疗（83%）。14名（6%）进展为HFNC失败；12名转入ICU并插管，2名患有先天性心脏病的患者在病房发生心肺骤停。双样本检验显示，失败患者更有可能有心脏病史（P = 0.026）、插管史（P = 0.040），并需要更高的吸入氧分数（FiO）（中位数100%；第25 - 75百分位数60 - 100%；P = <0.001）。医院调整后的逻辑回归进一步表明，失败患者更有可能接受更高FiO的治疗（比值比：38.3；95%置信区间：4.0 - 366.3；P = 0.002），而患细支气管炎的可能性较小（比值比：0.3；95%置信区间：0.1 - 0.9；P = 0.048）。
高FiO需求、插管史和心脏合并症是HFNC失败的相关预测因素。细支气管炎患者在ICU以外接受HFNC治疗失败的几率可能较低。《儿科肺病学》。2017；52：806 - 812。©2017威利期刊公司
