Department of Pediatric Medicine, Hamad Medical Corporation, Doha, Qatar.
Department of Pediatric Medicine, Sidra Medicine, Doha, Qatar.
Pediatr Pulmonol. 2020 Feb;55(2):455-461. doi: 10.1002/ppul.24553. Epub 2020 Jan 10.
Different modalities of noninvasive respiratory support have been recommended for the management of acute bronchiolitis in the pediatric intensive care unit (PICU). High-flow nasal cannula (HFNC) is among the new modalities that have been widely used in the last decade.
This is a retrospective study involving infants and young children between the ages of 1 month and 2 years during the respiratory season of 2016-2017 (October-May). We compared the failure rate of HFNC with the failure rates of bi-level positive airway pressure (BiPAP) vs continuous positive airway pressure (CPAP) in the management of acute bronchiolitis in the PICU. Failure was defined as a change to another respiratory support modality or endotracheal intubation and mechanical ventilation.
One hundred thirty-seven patients met the inclusion criteria, of which 77 patients needed HFNC, 10 needed CPAP, and 50 were on BiPAP. Among baseline characteristics, there were significant variations in age among the three groups. HFNC had a higher failure rate compared with the other two noninvasive ventilation modalities (50.6% for HFNC [n = 39 out of 77] vs 0% for CPAP [n = 0 out of 10] vs 8% for BiPAP [n = 4 out of 50], P < .01). Among the 39 patients who failed HFNC, 90% were successfully shifted to BiPAP and weaned off later, whereas the other 4 were intubated and required mechanical ventilation. However, all four patients who failed BiPAP were intubated and mechanically ventilated. No respiratory complications or mortalities were reported in the three groups. No differences were observed among the three groups in terms of the lengths of PICU or hospital stays.
We observed a higher failure rate of HFNC compared with BiPAP or CPAP in the management of infants and children with acute bronchiolitis in the PICU. Further prospective randomized trials are recommended to confirm this finding.
在儿科重症监护病房（PICU）中，已经推荐了不同的无创呼吸支持方式来治疗急性细支气管炎。高流量鼻导管（HFNC）是过去十年中广泛应用的新方法之一。
这是一项回顾性研究，涉及 2016-2017 年呼吸季节（10 月至 5 月）1 个月至 2 岁的婴儿和幼儿。我们比较了 HFNC 在 PICU 中治疗急性细支气管炎的失败率与双水平正压通气（BiPAP）与持续气道正压通气（CPAP）的失败率。失败定义为改用另一种呼吸支持方式或气管内插管和机械通气。
137 名符合纳入标准的患者中，77 名需要 HFNC，10 名需要 CPAP，50 名需要 BiPAP。在基线特征中，三组之间的年龄存在显著差异。HFNC 的失败率高于其他两种无创通气方式（HFNC[77 例中的 39 例（50.6%）]与 CPAP[10 例中 0 例（0%）]与 BiPAP[50 例中的 4 例（8%）]，P<0.01）。在 39 例 HFNC 失败的患者中，90%成功转为 BiPAP 并随后脱机，而其余 4 例则插管并需要机械通气。然而，所有 4 例 BiPAP 失败的患者均插管并进行机械通气。三组均未报告呼吸并发症或死亡。三组患者在 PICU 或住院时间方面无差异。
我们观察到在 PICU 中治疗急性细支气管炎时，HFNC 的失败率高于 BiPAP 或 CPAP。建议进一步进行前瞻性随机试验以证实这一发现。
