Milesi Christophe, Nogue Erika, Baleine Julien, Moulis Lionel, Pouyau Robin, Gavotto Arthur, Brossier David, Mortamet Guillaume, Cambonie Gilles
Pediatric Intensive Care Unit, Arnaud de Villeneuve University Hospital, Montpellier, France.
Clinical Research and Epidemiology Unit, CHU Montpellier, Univ Montpellier, Montpellier, France.
Pediatr Pulmonol. 2024 Apr;59(4):982-990. doi: 10.1002/ppul.26860. Epub 2024 Jan 10.
High-flow nasal cannula (HFNC) is commonly used as first step respiratory support in infants with moderate-to-severe acute viral bronchiolitis (AVB). This device, however, fails to effectively manage respiratory distress in about a third of patients, and data are limited on determinants of patient response. The respiratory rate-oxygenation (ROX) index is a relevant tool to predict the risk for HFNC failure in adult patients with lower respiratory tract infections. The primary objective of this study was to assess the relationship between ROX indexes collected before and 1 h after HFNC initiation, and HFNC failure occurring in the following 48 h in infants with AVB.
This is an ancillary study to the multicenter randomized controlled trial TRAMONTANE 2, that included 286 infants of less than 6 months with moderate-to-severe AVB. Collection of physiological variables at baseline (H0), and 1 h after HFNC (H1), included heart rate (HR), respiratory rate (RR), fraction of inspired oxygen (FiO), respiratory distress score (modified Wood's Clinical Asthma Score [mWCAS]), and pain and discomfort scale (EDIN). ROX and ROX-HR were calculated as and , respectively. Predefined HFNC failure criteria included increase in respiratory distress score or RR, increase in discomfort, and severe apnea episodes. The accuracies of ROX, ROX-HR indexes and clinical variable to predict HFNC failure were assessed using receiver operating curve analysis. We analyzed predictive factors of HFNC failure using multivariate logistic regressions.
HFNC failure occurred in 111 of 286 (39%) infants, and for 56 (50% of the failure) of them within the first 6 h. The area under the curve of ROX indexes at H0 and H1 were, respectively, 0.56 (95% confidence interval [CI] 0.48-0.63, p = 0.14), 0.56 (95% CI 0.49-0.64, p = 0.09). ROX-HR performances were better but remained poorly discriminant. HFNC failure was associated with higher mWCAS score at H1 (p < 0.01) and lower decrease in EDIN scale during the first hour of HFNC delivery (p = 0.02). In the multivariate analyses, age and mWCAS score were were found to be independent factors associated with HFNC failure at H0. At H1, weight and mWCAS were associated factors.
In this study, neither ROX index, nor physiological variables usually collected in infants with AVB had early discriminatory capacity to predict HFNC failure.
高流量鼻导管（HFNC）通常用作中重度急性病毒性细支气管炎（AVB）婴儿的第一步呼吸支持。然而，该设备在约三分之一的患者中未能有效控制呼吸窘迫，且关于患者反应决定因素的数据有限。呼吸频率 - 氧合（ROX）指数是预测下呼吸道感染成年患者HFNC失败风险的相关工具。本研究的主要目的是评估HFNC启动前和启动后1小时收集的ROX指数与AVB婴儿在接下来48小时内发生的HFNC失败之间的关系。
这是一项多中心随机对照试验TRAMONTANE 2的辅助研究，该试验纳入了286名6个月以下的中重度AVB婴儿。在基线（H0）和HFNC后1小时（H1）收集生理变量，包括心率（HR）、呼吸频率（RR）、吸入氧分数（FiO）、呼吸窘迫评分（改良伍德临床哮喘评分[mWCAS]）以及疼痛和不适量表（EDIN）。ROX和ROX - HR分别计算为 和 。预先定义的HFNC失败标准包括呼吸窘迫评分或RR增加、不适增加以及严重呼吸暂停发作。使用受试者工作特征曲线分析评估ROX、ROX - HR指数和临床变量预测HFNC失败的准确性。我们使用多因素逻辑回归分析HFNC失败的预测因素。
286名婴儿中有111名（39%）发生HFNC失败，其中56名（失败患者的50%）在最初6小时内发生。H0和H1时ROX指数的曲线下面积分别为0.56（95%置信区间[CI] 0.48 - 0.63，p = 0.14）、0.56（95% CI 0.49 - 0.64，p = 0.09）。ROX - HR的表现更好，但区分能力仍然较差。HFNC失败与H1时较高的mWCAS评分（p < 0.01）以及HFNC开始后第一小时内EDIN量表下降较少（p = 0.02）相关。在多因素分析中，发现年龄和mWCAS评分是与H0时HFNC失败相关的独立因素。在H1时，体重和mWCAS是相关因素。
在本研究中，ROX指数和通常在AVB婴儿中收集的生理变量均没有早期区分能力来预测HFNC失败。
