Divisions of Pediatric Critical Care Medicine,
Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland; and.
Hosp Pediatr. 2021 Jan;11(1):94-99. doi: 10.1542/hpeds.2020-001602.
To describe the rate of high-flow nasal cannula (HFNC) nonresponse and paired physiometric responses (changes [∆] in heart rate [HR] and respiratory rate [RR]) before and after HFNC initiation in hospitalized children with bronchiolitis.
We performed a single-center, prospective descriptive study in a PICU within a quaternary referral center, assessing children aged ≤2 years admitted for bronchiolitis on HFNC from November 2017 to March 2020. We excluded for cystic fibrosis, airway anomalies, pulmonary hypertension, tracheostomy, neuromuscular disease, congenital heart disease, or preadmission intubation. Primary outcomes were paired ∆ and %∆ in HR and RR before and after HFNC initiation. Secondary outcomes were HFNC nonresponse rate (ie, intubation or transition to noninvasive positive pressure ventilation). Analyses included χ, Student's , Wilcoxon rank, and paired testing.
Of the 172 children studied, 56 (32.6%) experienced HFNC nonresponse at a median of 14.4 (interquartile range: 4.8-36) hours and 11 (6.4%) were intubated. Nonresponders had a greater frequency of bacterial pneumonia, but otherwise no major differences in demographics, comorbidities, or viral pathogens were noted. Responders experienced reductions in both %ΔRR (-17.1% ± 15.8% vs +5.3% ± 22.3%) and %ΔHR (-6.5% ± 10.5% vs 0% ± 10.9%) compared with nonresponders.
In this prospective, observational cohort study, we provide baseline data describing expected physiologic changes after initiation of HFNC for children admitted to the PICU for bronchiolitis. In our descriptive analysis, patients with comorbid bacterial pneumonia appear to be at additional risk for subsequent HFNC nonresponse.
描述毛细支气管炎住院患儿使用高流量鼻导管（HFNC）前后的无反应率和配对生理指标变化（心率[HR]和呼吸率[RR]的变化[∆]）。
我们在一家四级转诊中心的 PICU 内进行了一项单中心前瞻性描述性研究，评估了 2017 年 11 月至 2020 年 3 月期间因毛细支气管炎而接受 HFNC 治疗的≤2 岁患儿。我们排除了囊性纤维化、气道异常、肺动脉高压、气管切开术、神经肌肉疾病、先天性心脏病或入院前插管的患儿。主要结局为 HFNC 起始前后 HR 和 RR 的配对 ∆和%∆。次要结局为 HFNC 无反应率（即插管或过渡至无创正压通气）。分析包括 χ²检验、Student's t 检验、Wilcoxon 秩和检验和配对检验。
在 172 名研究患儿中，56 名（32.6%）在中位时间 14.4（四分位间距：4.8-36）小时后发生 HFNC 无反应，11 名（6.4%）需要插管。无反应者细菌性肺炎的发生率更高，但在人口统计学特征、合并症或病毒病原体方面无其他重大差异。与无反应者相比，反应者的 RR 变化百分比（-17.1%±15.8% vs.+5.3%±22.3%）和 HR 变化百分比（-6.5%±10.5% vs. 0%±10.9%）均有显著降低。
在这项前瞻性观察队列研究中，我们提供了关于毛细支气管炎患儿入住 PICU 后使用 HFNC 初始时预期生理变化的基线数据。在我们的描述性分析中，合并细菌性肺炎的患儿似乎有更高的 HFNC 无反应风险。
