Department of Pediatrics, University Hospital of Rostock, Germany.
Department of Neonatology, Südstadt Hospital Rostock, Germany.
Respir Med. 2017 Oct;131:210-214. doi: 10.1016/j.rmed.2017.08.027. Epub 2017 Sep 1.
High-flow nasal cannula (HFNC) is a technique of oxygen supply, initially being used as a potentially less-invasive alternative to nasal continuous positive airway pressure (nCPAP) for premature infants/neonates, which nowadays crosses the border of neonatal care. HFNC builds up a positive end-expiratory pressure (PEEP) but lacks the opportunity for continuous monitoring. Therefore, pressure-depending complications are a risk. Our goal was to evaluate the current use of HFNC in Germany regarding indications, techniques of application and complications experienced.
We used a questionnaire sent to 226 pediatric clinics.
We received responses from 67 pediatric clinics (29.6%). HFNC was applied in the age group of 8 to 14 years in 42% and between 14 and 18 years in 33% of the clinics. 54% of the clinics have been using HFNC for more than 3 years. Applied flow rates varied strongly among the clinics. 70% of the clinics use HFNC outside of the established indications (alternative to nCPAP for premature infants and neonates, bronchiolitis) for pneumonia, support after extubation and non-adherence to nCPAP. Severe complications such as pneumothorax have been seen by 17,9% of the clinics.
We reported for the first time a nationwide overview about the expanded use of HFNC in pediatric clinics. Our results emphasize the fact that, even though HFNC is widely accepted as a non-invasive procedure there is still a potential of severe side effects. Therefore the use of HFNC should be monitored continuously and closely within an intensive or intermediate care unit.
高流量鼻导管（HFNC）是一种供氧技术，最初被用作早产儿/新生儿替代鼻塞持续气道正压通气（nCPAP）的潜在非侵入性方法，如今已跨越新生儿护理的边界。HFNC 会产生正呼气末压（PEEP），但缺乏持续监测的机会。因此，依赖压力的并发症是一种风险。我们的目标是评估德国目前 HFNC 的使用情况，包括适应证、应用技术和所经历的并发症。
我们使用了一份发送给 226 家儿科诊所的问卷。
我们收到了 67 家儿科诊所（29.6%）的回复。HFNC 在年龄组为 8 至 14 岁的诊所中应用率为 42%，在 14 至 18 岁的诊所中应用率为 33%。54%的诊所使用 HFNC 已经超过 3 年。应用的流速在各诊所之间差异很大。70%的诊所将 HFNC 用于超出既定适应证的情况（早产儿和新生儿的 nCPAP 替代、细支气管炎），用于肺炎、拔管后的支持和不遵守 nCPAP。17.9%的诊所报告了严重并发症，如气胸。
我们首次报告了全国范围内儿科诊所扩大使用 HFNC 的情况。我们的结果强调了一个事实，即使 HFNC 作为一种非侵入性的治疗方法被广泛接受，但仍存在严重副作用的风险。因此，HFNC 的使用应在重症监护或中级监护病房内进行持续和密切的监测。
