Service de Médecine Infantile et Pneumologie pédiatrique, CHU Timone-Enfants, 264 rue Saint-Pierre, 13385, Marseille Cedex 5, France.
Service d'Evaluation médicale, Pôle de Santé publique, Hôpital de la Conception, Marseille, France.
Eur J Pediatr. 2019 Oct;178(10):1479-1484. doi: 10.1007/s00431-019-03434-4. Epub 2019 Aug 1.
High-flow nasal cannula (HFNC) is frequently used in infants with acute viral bronchiolitis outside pediatric intensive care units (PICU). A structured questionnaire was sent out to pediatricians of all public French hospitals with pediatric emergency and/or general pediatric departments on their use of HFNC outside PICU (department using HFNC, number of available devices, monitoring, criteria for initiating or stopping HFNC, and personal comments on HFNC). Of the 166 eligible hospitals, 135 answered (96 general and 39 university hospitals; 81.3%), for a total of 217 answering pediatricians. Seventy-two hospitals (53.3%) used HFNC in acute bronchiolitis outside PICU, particularly, general hospitals (59.4% vs 38.5%), and mostly in pediatric general departments (75%). Continuous patient monitoring with a cardiorespiratory monitor was usual (n = 58, 80%). Nursing staff was responsible for 2.7 children on HFNC and checked vital signs 8.6 times per day. Criteria for HFNC initiation and withdrawal were not standardized. Pediatricians had a positive opinion of HFNC and were willing to extend its use to other diseases.Conclusion: Use of HFNC outside PICU in infants with acute bronchiolitis is now usual, but urgently requires guidelines. What is Known: • Acute viral bronchiolitis treatment is only supportive • High-flow nasal cannula (HFNC) is a respiratory support accumulating convincing clinical evidence in bronchiolitis • This latter treatment is usually proposed in pediatric intensive care unit (PICU) What is New: • HFNC are increasingly used outside PICU in bronchiolitis, particularly, in general hospitals and in pediatric general departments • Pediatricians are enthusiastic about this device, but validated criteria for initiation and withdrawal are lacking • Guidelines for the use of HFNC outside PICU are urgently required.
高流量鼻导管（HFNC）常用于儿科重症监护病房（PICU）外患有急性病毒性细支气管炎的婴儿。我们向法国所有公立医院的儿科医生发送了一份有关他们在 PICU 外使用 HFNC 的情况的结构化问卷，包括使用 HFNC 的科室、可用设备的数量、监测、开始或停止 HFNC 的标准以及个人对 HFNC 的评价。在 166 家符合条件的医院中，有 135 家（96 家综合医院和 39 家大学医院；81.3%）做出了回应，共有 217 名儿科医生参与了调查。72 家医院（53.3%）在 PICU 外的急性细支气管炎中使用 HFNC，特别是综合医院（59.4%比 38.5%），且主要在儿科综合科室使用（75%）。通常使用心肺监测仪对患者进行连续监测（n=58，80%）。护理人员负责 2.7 名接受 HFNC 治疗的患儿，每天检查生命体征 8.6 次。HFNC 的开始和停止标准尚未标准化。儿科医生对 HFNC 的应用持积极态度，并愿意将其应用于其他疾病。结论：目前在 PICU 外使用 HFNC 治疗急性细支气管炎已较为常见，但迫切需要制定相关指南。已知情况：急性病毒性细支气管炎的治疗仅为支持性治疗。高流量鼻导管（HFNC）是一种呼吸支持方法，在细支气管炎中积累了令人信服的临床证据。这种治疗方法通常在儿科重症监护病房（PICU）中提出。新情况：HFNC 在细支气管炎中越来越多地在 PICU 外使用，特别是在综合医院和儿科综合科室。儿科医生对这种设备很感兴趣，但缺乏开始和停止的验证标准。迫切需要制定 PICU 外使用 HFNC 的指南。
