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Objectives: Use of high-flow nasal cannula (HFNC) for bronchiolitis has increased, but data describing the current use and impact of this therapy are limited. Our objective with this study was to describe the use of HFNC for bronchiolitis in a pediatric emergency department (ED) from 2013 to 2019 and to explore associations with clinical outcomes.
Methods: This was a retrospective cohort study of children aged 2 to 24 months with the diagnosis of bronchiolitis. The primary outcome was HFNC initiation in the ED. Secondary outcomes included admission rate, ICU (PICU) admission, transfer to PICU from floor, and endotracheal intubation. An adjusted interrupted times series analysis was performed to analyze changes in rates of primary and secondary outcomes over time.
Results: In total 11 149 children met inclusion criteria; 902 (8.1%) were initiated on HFNC. The rate of HFNC initiation increased from 1.3% in 2012-2013 to 17.0% in 2018-2019 ( ≤ .001). Less than 30% of children initiated on HFNC were hypoxic. There were no significant changes over time in rates of hospital admission, PICU admission, or PICU transfer, adjusting for clinical severity, seasonality, and provider variation. Intubation rate increased over the study period.
Conclusions: We found a 13-fold increase in HFNC use over a 6-year period with no evidence of improvement in clinically meaningful outcomes. Clinical benefit should be clearly defined before further expansion of the use of HFNC for bronchiolitis in the ED.
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http://dx.doi.org/10.1542/hpeds.2020-002774 | DOI Listing |
Eur J Pediatr
December 2024
Neonatal Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padova, Padua, Italy.
Unlabelled: The use of High-Flow Nasal Cannula (HFNC) in children with bronchiolitis is globally increased in the last decade, despite the lack of evidence-based and universal guidelines to standardize their application in the clinical practice. In this systematic review, we aimed to analyse the completeness of previous studies on HFNC interventions in children with bronchiolitis using an adapted Template for Intervention Description and Replication (TIDieR) checklist. Randomized clinical trials (RCTs) and cohort studies on children younger than 2 years old with a diagnosis of bronchiolitis were included.
View Article and Find Full Text PDFPediatr Pulmonol
December 2024
Pediatric Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.
Introduction: Lung ultrasound (LUS) has emerged as a reliable, noninvasive tool for bedside assessment of acute bronchiolitis (AB) in infants. Its role in guiding therapeutic decisions is increasingly recognized.
Aims: This study aimed to determine the predictive value of LUS in identifying infants with AB at risk of HFNC therapy failure.
PLoS One
November 2024
Pediatric Intensive Care Unit, Instituto da Criança, Universidade de São Paulo, São Paulo, São Paulo, Brazil.
Objective: To assess a comparative analysis of the ROX index, Wood-Downes-Ferrés score (WDF), p-ROXI, and the SpO2/FiO2 ratio as predictors of high-flow nasal cannula (HFNC) failure in children hospitalized for bronchiolitis.
Methods: Data were extracted from the clinical trial "Comparison between HFNC and NIV in children with acute respiratory failure caused by bronchiolitis" conducted at a tertiary Brazilian hospital (Emergency Department and PICU). The inclusion criteria were children under 2 years of age admitted for bronchiolitis who developed mild to moderate respiratory distress and were eligible for HFNC therapy.
BMJ Open
November 2024
Department of Acute Child Health, Children's Hospital for Wales, Cardiff, UK.
Pediatr Pulmonol
October 2024
Bambino Gesù Children's Hospital IRCCS, Hospital University Pediatrics Clinical Area, Rome, Italy.
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