Department of Paediatrics and Child Health, New Somerset Hospital, Faculty of Health Sciences, University of Cape Town, 7700, Cape Town, South Africa.
Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Faculty of Health Sciences, University of Cape Town, 7700, Cape Town, South Africa.
J Trop Pediatr. 2020 Dec 1;66(6):612-620. doi: 10.1093/tropej/fmaa024.
In settings where access to paediatric intensive care unit (PICU) facilities is constrained and transfer capacity is limited, High Flow Nasal Cannulae (HFNC) might fill an important service gap. The aim of this study was to document the effect of HFNC on the outcomes of children admitted with severe respiratory disease at a regional hospital without a PICU in Cape Town, South Africa. It is a 4-year retrospective analysis documenting two periods of 2 years each, one before (2013-15) and one after (2016-18) the initiation of HFNC use. Patients were between the ages of 2 months and 13 years and had been admitted to a paediatric ward. Outcomes were defined by the need for transfer to a tertiary hospital, the need for invasive ventilation and death. There were 90 instances of HFNC use with a significant reduction in the number of children who were transferred (59 vs. 31), invasively ventilated (20 vs. 6, p ≤ 0.01) and who died (3 vs. 0, p = 0.02). Before HFNC implementation, there was also a significantly greater proportion of transferred children who remained on low flow nasal cannulae (15 vs. 2, p ≤ 0.001) at the tertiary hospital. Children who failed HFNC use tended to do this within a day of initiation (Median 11 vs. 60 h for success, p ≤ 0.001). There were no complications related to its use. We believe that in our setting the utilization of HFNC has helped to timeously and accurately identify children needing to be transferred and may mitigate against severe respiratory disease progression.
在儿科重症监护病房（PICU）设施有限且转院能力有限的情况下，高流量鼻导管（HFNC）可能填补重要的服务空白。本研究旨在记录 HFNC 在南非开普敦一家没有 PICU 的地区医院因严重呼吸疾病入院的儿童的结局中的作用。这是一项为期 4 年的回顾性分析，记录了两个 2 年的时期，一个在 HFNC 使用之前（2013-15 年），一个在 HFNC 使用之后（2016-18 年）。患者年龄在 2 个月至 13 岁之间，曾被收治于儿科病房。结局定义为需要转往三级医院、需要有创通气和死亡。共使用了 90 例 HFNC，需要转院的儿童数量显著减少（59 例比 31 例），需要有创通气的儿童数量也显著减少（20 例比 6 例，p≤0.01），死亡的儿童数量更少（3 例比 0 例，p=0.02）。在实施 HFNC 之前，转往三级医院的儿童中，仍使用低流量鼻导管的比例也显著更高（15 例比 2 例，p≤0.001）。HFNC 治疗失败的儿童往往在开始治疗的一天内失败（中位时间 11 小时比成功组的 60 小时，p≤0.001）。HFNC 使用过程中没有相关并发症。我们认为，在我们的环境中，HFNC 的应用有助于及时、准确地识别需要转院的儿童，并可能减轻严重呼吸疾病的进展。
