D'Arienzo David, Sanvido Liam, Amin Reshma, Diskin Catherine, Cohen Eyal
Complex Care Program, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Division of General Pediatrics, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
J Hosp Med. 2025 Jul;20(7):669-676. doi: 10.1002/jhm.13571. Epub 2024 Dec 17.
To describe the patient characteristics, indications, and clinical outcomes of home high flow nasal cannula (HFNC) among pediatric patients. To evaluate secular trends in home HFNC initiation between 2013 and 2022.
A retrospective review of all children on home HFNC between 2013 and 2023 was conducted at a tertiary care pediatric hospital in Ontario, Canada. Descriptive statistics were used to summarize results and identify indications for home HFNC initiation. Mann-Kendall Trend test was used to assess trends in HHF initiation between 2013 and 2022.
A total of 35 patients, ages 6 months-14 years old, were started on home HFNC between 2013 and 2023. HFNC initiation increased over time, from 0 patients in 2013-2016 to nine patients per year in 2021 and 2022 (p < .001). Home HFNC was almost exclusively prescribed for children with multisystem conditions, 77% with an underlying genetic disorder, and 77% with prior home feeding tube use. Most children (83%) had multiple indications leading to initiation of home HFNC. The main indications included the following: (i) upper airway obstruction (66%), (ii) clearance of retained CO (57%), (iii) increased work of breathing without sleep-disordered breathing (29%), (iv) promotion of secretion clearance/plastic bronchitis (29%), and (v) palliative care (14%). In addition, 37% did not tolerate a previous trial of Continuous/Bi-Level Positive Airway Pressure. Complications were rare, with only two children developing epistaxis requiring an emergency department visit and 4 children requiring escalation in home respiratory support to CPAP or BiPAP.
HFNC is increasingly being initiated among children in the home setting for varied indications. Preliminary data suggests few complications and a need for escalation of therapy with home HFNC.
描述儿科患者家庭高流量鼻导管（HFNC）的患者特征、适应证及临床结局。评估2013年至2022年家庭HFNC启用情况的长期趋势。
对加拿大安大略省一家三级护理儿童医院2013年至2023年期间所有使用家庭HFNC的儿童进行回顾性研究。采用描述性统计来总结结果并确定家庭HFNC启用的适应证。使用曼-肯德尔趋势检验评估2013年至2022年家庭HFNC启用情况的趋势。
2013年至2023年期间，共有35例年龄在6个月至14岁的患者开始使用家庭HFNC。HFNC的启用随时间增加，从2013 - 2016年的0例患者增加到2021年和2022年的每年9例（p < 0.001）。家庭HFNC几乎完全用于患有多系统疾病的儿童，77%有潜在遗传疾病，77%之前使用过家庭喂养管。大多数儿童（83%）有多种适应证导致开始使用家庭HFNC。主要适应证包括：（i）上气道梗阻（66%），（ii）清除潴留的二氧化碳（57%），（iii）无睡眠呼吸紊乱但呼吸功增加（29%），（iv）促进分泌物清除/塑料支气管炎（29%），以及（v）姑息治疗（14%）。此外，37%的患者不能耐受先前的持续气道正压通气/双水平气道正压通气试验。并发症很少见，只有2例儿童发生鼻出血需要到急诊科就诊，4例儿童需要将家庭呼吸支持升级为持续气道正压通气或双水平气道正压通气。
家庭环境中越来越多的儿童因各种适应证开始使用HFNC。初步数据表明并发症很少，且家庭HFNC治疗有升级的需求。
