Chang Chih-Ching, Lin Yi-Chen, Chen Tzu-Chun, Lin Jainn-Jim, Hsia Shao-Hsuan, Chan Oi-Wa, Lee En-Pei
Department of Respiratory Therapy, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Chang Gung University School of Medicine, Taoyuan, Taiwan.
Front Pediatr. 2021 May 7;9:664180. doi: 10.3389/fped.2021.664180. eCollection 2021.
High-flow nasal cannulas (HFNCs) show potential in the application of positive pressure, improving gas exchange, and decreasing work of breathing in patients with acute respiratory distress. The aims of this study were to elucidate the indications for HFNC therapy in children of all ages and diagnoses, and to evaluate the efficacy and risk factors for failure of HFNC therapy in children with acute respiratory distress with hypoxia in a pediatric intensive care unit. We conducted this retrospective cohort study at a tertiary pediatric intensive care unit between January 1, 2018 and December 31, 2020. All children, from 1 month to 18 years of age, with acute respiratory distress with hypoxia and HFNC therapy were eligible. The clinical data were reviewed. One hundred and two children met the eligibility criteria for the study, of whom 57 (55.9%) were male, and the mean age was 7.00 6.79 years. Seventy-eight (76.5%) of the children had underlying disorders. The most common indications for the use of HFNC therapy were pneumonia (40, 39.2%), sepsis-related respiratory distress (17, 16.7%), and bronchiolitis (16, 15.7%). The failure rate was 15.7% (16 of 102 children). Higher initial and maximum fraction of inspiration O2 levels and lower initial and lowest SpO2/FiO2 (S/F) ratio were early and possible signs of failure requiring escalation of respiratory support. In our population, we found that HFNC therapy could be initiated as the first-line therapy for various etiologies of acute respiratory distress with hypoxia in a pediatric intensive care unit and for all age groups.
高流量鼻导管（HFNC）在应用正压、改善气体交换以及降低急性呼吸窘迫患者的呼吸功方面显示出潜力。本研究的目的是阐明各年龄段和诊断类型儿童HFNC治疗的适应证，并评估儿科重症监护病房中急性呼吸窘迫伴缺氧儿童HFNC治疗失败的疗效和危险因素。我们于2018年1月1日至2020年12月31日在一家三级儿科重症监护病房进行了这项回顾性队列研究。所有1个月至18岁、患有急性呼吸窘迫伴缺氧且接受HFNC治疗的儿童均符合条件。对临床数据进行了回顾。102名儿童符合该研究的入选标准，其中57名（55.9%）为男性，平均年龄为7.00±6.79岁。78名（76.5%）儿童有基础疾病。使用HFNC治疗最常见的适应证是肺炎（40例，39.2%）、脓毒症相关呼吸窘迫（17例，16.7%）和细支气管炎（16例，15.7%）。失败率为15.7%（102名儿童中的16名）。较高的初始和最大吸入氧分数水平以及较低的初始和最低脉搏血氧饱和度/吸入氧分数（S/F）比值是需要升级呼吸支持的早期且可能的失败迹象。在我们的研究人群中，我们发现HFNC治疗可作为儿科重症监护病房中各年龄段急性呼吸窘迫伴缺氧各种病因的一线治疗方法。
