Division of Pediatric Emergency Medicine, Dokuz Eylul University, School of Medicine, Izmir, Turkey.
Pediatr Pulmonol. 2018 Jun;53(6):809-815. doi: 10.1002/ppul.23981. Epub 2018 Mar 12.
High-flow nasal cannula (HFNC) is a new treatment option for pediatric respiratory distress and we aimed to assess early predictive factors of unresponsiveness to HFNC therapy in a pediatric emergency department (ED).
Patients who presented with respiratory distress and were treated by HFNC, were included. The age, gender, weight, medical history, diagnosis, vital signs, oxygen saturation/fraction of inspired oxygen (SpO /FiO ) ratio, modified Respiratory Distress Assessment Instrument (mRDAI) scores, medical interventions, duration of HFNC therapy, time to escalation, adverse effects, and laboratory test results were obtained from medical and nursing records. The requirement of a higher level of respiratory support due to unchanged or increased RR compared to initial RR, incipient, or progressive respiratory acidosis, incipient hemodynamic instability was defined as unresponsiveness to HFNC.
The study enrolled 154 children with a median age of 10 months (interquartile range [IQR], 5.7-22.5 months). The diagnosis was acute bronchiolitis in 59 patients (38.3%), bacterial pneumonia in 64 patients (41.6%), and atypical or viral pneumonia in 31 patients (20.1%). Twenty-five patients (16.2%) were in the unresponsive group, and the median time for escalating respiratory support was 7 h (IQR: 4-20 h). The unresponsive group had lower SpO and SpO /FiO (SF) ratio on admission, lower venous pH, and higher partial pressure of carbon dioxide (pCO ) (P = 0.002, P = 0.012, and P = 0.001, respectively). Also the alteration of RR, mRDAI score, and SF ratio at the first hour was greater in the responsive group. The cut-off value of SF ratio at the first hour of HFNC was 195 for unresponsiveness.
The low initial SpO and SF ratio, respiratory acidosis, and SF ratio less than 195 at the first hours of treatment were related to unresponsiveness to HFNC therapy in our pediatric emergency department.
高流量鼻导管（HFNC）是一种治疗小儿呼吸窘迫的新方法，本研究旨在评估儿科急诊中 HFNC 治疗无反应的早期预测因素。
纳入因呼吸窘迫而接受 HFNC 治疗的患儿。从病历和护理记录中获取患儿的年龄、性别、体重、既往病史、诊断、生命体征、血氧饱和度/吸入氧分数（SpO /FiO ）比值、改良呼吸窘迫评估工具（mRDAI）评分、医疗干预措施、HFNC 治疗时间、升级时间、不良反应以及实验室检查结果。因 RR 与初始 RR 相比无变化或增加、出现或逐渐加重的呼吸性酸中毒、出现初始的血流动力学不稳定而需要更高水平的呼吸支持定义为 HFNC 治疗无反应。
本研究共纳入了 154 名患儿，中位年龄为 10 个月（四分位距 [IQR]：5.7-22.5 个月）。59 名患儿（38.3%）的诊断为急性细支气管炎，64 名患儿（41.6%）为细菌性肺炎，31 名患儿（20.1%）为非典型或病毒性肺炎。25 名患儿（16.2%）为无反应组，升级呼吸支持的中位时间为 7 小时（IQR：4-20 小时）。无反应组入院时的 SpO 和 SpO /FiO 比值较低，静脉血 pH 值较低，二氧化碳分压（pCO ）较高（P = 0.002、P = 0.012 和 P = 0.001）。另外，在第 1 小时时 RR、mRDAI 评分和 SF 比值的变化在有反应组中更大。HFNC 治疗第 1 小时 SF 比值的截断值为 195，用于预测无反应。
在本儿科急诊中，初始 SpO 和 SF 比值较低、呼吸性酸中毒和治疗第 1 小时 SF 比值小于 195 与 HFNC 治疗无反应有关。
