Babl Franz E, Franklin Donna, Schlapbach Luregn J, Oakley Ed, Dalziel Stuart, Whitty Jennifer A, Neutze Jocelyn, Furyk Jeremy, Craig Simon, Fraser John F, Jones Mark, Schibler Andreas
Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia.
Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.
J Paediatr Child Health. 2020 Jun;56(6):950-955. doi: 10.1111/jpc.14799. Epub 2020 Feb 11.
Nasal high-flow oxygen therapy is increasingly used in infants for supportive respiratory therapy in bronchiolitis. It is unclear whether enteral hydration is safe in children receiving high-flow.
We performed a planned secondary analysis of a multi-centre, randomised controlled trial of infants aged <12 months with bronchiolitis and an oxygen requirement. Children were assigned to treatment with either high-flow or standard-oxygen therapy with optional rescue high-flow. We assessed adverse events based on how children on high-flow were hydrated: intravenously (IV), via bolus or continuous nasogastric tube (NGT) or orally.
A total of 505 patients on high-flow via primary study assignment (n = 408), primary treatment (n = 10) or as rescue therapy (n = 87) were assessed. While on high flow, 15 of 505 (3.0%) received only IV fluids, 360 (71.3%) received only enteral fluids and 93 (18.4%) received both IV and enteral fluids. The route was unknown in 37 (7.3%). Of the 453 high-flow infants hydrated enterally patients could receive one or more methods of hydration; 80 (15.8%) received NGT bolus, 217 (43.0%) NGT continuous, 118 (23.4%) both bolus and continuous, 32 (6.3%) received only oral hydration and 171 (33.9%) a mix of NGT and oral hydration. None of the patients receiving oral or NGT hydration on high-flow sustained pulmonary aspiration (0%; 95% confidence interval N/A); one patient had a pneumothorax (0.2%; 95% confidence interval 0.0-0.7%).
The vast majority of children with hypoxic respiratory failure in bronchiolitis can be safely hydrated enterally during the period when they receive high-flow.
鼻高流量氧疗在婴儿毛细支气管炎的支持性呼吸治疗中应用越来越广泛。目前尚不清楚在接受高流量氧疗的儿童中进行肠内补液是否安全。
我们对一项针对年龄小于12个月、患有毛细支气管炎且有吸氧需求的婴儿的多中心随机对照试验进行了计划中的二次分析。将儿童分为接受高流量氧疗或标准氧疗并可选择高流量氧疗进行抢救的治疗组。我们根据高流量氧疗患儿的补液方式评估不良事件：静脉补液（IV）、推注或持续鼻胃管（NGT）补液或口服补液。
通过初步研究分配（n = 408）、主要治疗（n = 10）或作为抢救治疗（n = 87）接受高流量氧疗的505例患者接受了评估。在接受高流量氧疗期间，505例患者中有15例（3.0%）仅接受静脉补液，360例（71.3%）仅接受肠内补液，93例（18.4%）同时接受静脉和肠内补液。37例（7.3%）的补液途径未知。在453例接受肠内补液的高流量氧疗婴儿中，患者可接受一种或多种补液方法；80例（15.8%）接受鼻胃管推注补液，217例（43.0%）接受鼻胃管持续补液，118例（23.4%）同时接受推注和持续补液，32例（6.3%）仅接受口服补液，171例（33.9%）接受鼻胃管和口服补液的混合方式。接受高流量氧疗时通过口服或鼻胃管补液的患者均未发生持续性肺误吸（0%；95%置信区间不适用）；1例患者发生气胸（0.2%；95%置信区间0.0 - 0.7%）。
绝大多数毛细支气管炎合并低氧性呼吸衰竭的儿童在接受高流量氧疗期间可安全地进行肠内补液。
