Davison Michelle, Watson Mike, Wockner Leesa, Kinnear Frances
Department of Emergency Medicine and Children's Service, The Prince Charles Hospital, Brisbane, Queensland, Australia.
QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
Emerg Med Australas. 2017 Apr;29(2):198-203. doi: 10.1111/1742-6723.12741.
The objective was to examine the safety and efficacy of high-flow nasal cannula (HFNC) therapy for children with bronchiolitis in a non-tertiary paediatric setting.
This was a single-centre retrospective study conducted over 26 months (March 2013-April 2015) on children aged 1-23 months with suspected bronchiolitis, who commenced on HFNC therapy in either the ED or the ward. Changes with respect to baseline data were analysed for effect on work of breathing (WOB), heart rate (HR) and respiratory rate (RR). Data was analysed using a linear mixed effects model and adjusted for age (≤12 months and >12 months) and location (ED vs ward). Transfer to a tertiary environment, escalation of care and adverse event rates were also recorded.
A total of 61 children commenced on HFNC therapy, with flow rates ranging from 0.6 to 3.3L/kg/min. The proportion of patients with higher WOB scores appeared to reduce within 60 min of initiation of therapy. There was also a progressive reduction in surrogate markers of respiratory distress (HR and RR), with significant reductions evident by 60 min (P < 0.05). There were no adverse events related to HFNC therapy. The transfer rate was 13%. It was predominantly due to lack of improvement of physiological parameters post initiation of HFNC therapy. None of the transferred patients required escalation of care.
Within the limitations of this study it appears HFNC therapy may be safely commenced in both age groups in a non-tertiary ED or ward, with an appropriate level of observation and robust transfer criteria.
本研究旨在探讨在非三级儿科环境中，高流量鼻导管（HFNC）治疗小儿细支气管炎的安全性和有效性。
这是一项单中心回顾性研究，研究时间为26个月（2013年3月至2015年4月），研究对象为1至23个月疑似患有细支气管炎且在急诊科或病房开始接受HFNC治疗的儿童。分析基线数据的变化对呼吸功（WOB）、心率（HR）和呼吸频率（RR）的影响。使用线性混合效应模型对数据进行分析，并根据年龄（≤12个月和>12个月）和地点（急诊科与病房）进行调整。还记录了转至三级医疗机构、护理升级和不良事件发生率。
共有61名儿童开始接受HFNC治疗，流速范围为0.6至3.3L/kg/min。治疗开始后60分钟内，呼吸功评分较高的患者比例似乎有所降低。呼吸窘迫的替代指标（HR和RR）也逐渐降低，60分钟时显著降低（P<0.05）。未发生与HFNC治疗相关的不良事件。转诊率为13%。主要原因是HFNC治疗开始后生理参数未改善。所有转诊患者均无需升级护理。
在本研究的局限性范围内，在非三级急诊科或病房，对两个年龄组的患者，似乎均可在适当的观察水平和严格的转诊标准下安全地开始HFNC治疗。
