High-flow nasal cannula oxygen for bronchiolitis in a pediatric ward: a pilot study

Abstract

High-flow nasal cannula (HFNC) is a widely used ventilatory support in children with bronchiolitis in the intensive care setting. No data is available on HFNC use in the general pediatric ward. The aim of this study was to evaluate the feasibility of HFNC oxygen therapy in infants hospitalized in a pediatric ward for moderate-severe bronchiolitis and to assess the changes in ventilatory parameters before and after starting HFNC support. This prospective observational pilot study was carried out during the bronchiolitis season 2011-2012 in a pediatric tertiary care academic center in Italy. Interruptions of HFNC therapy and possible side effects or escalation to other forms of respiratory support were recorded. Oxygen saturation (SpO2), end-tidal carbon dioxide (ETCO2), and respiratory rate (RR), measured for a baseline period of 1 h before and at specific time intervals in 48 h after the start of HFNC were recorded. Twenty-seven infants were included (median age 1.3 months; absolute range 0.3-8.5). No adverse events, no premature HFNC therapy termination, and no escalation to other forms of respiratory support were recorded. Median SpO2 significantly increased by 1-2 points after changing from standard oxygen to HFNC (p <0.001). Median ETCO2 and RR rapidly decreased by 6-8 mmHg and 13-20 breaths per minute, respectively, in the first 3 h of HFNC therapy (p <0.001) and remained steady thereafter.

Conclusions: Use of HFNC for oxygen administration is feasible for infants with moderate-severe bronchiolitis in a general pediatric ward. In these children, HFNC therapy improves oxygen saturation levels and seems to be associated with a decrease in both ETCO2 and RR.

Fig. 1

Patients flow-chart. HFNC high-flow nasal cannulae; HS hemodynamically significant; BPD bronchopulmonary dysplasia

Fig. 2

ETCO2 values distribution over time pre- (baseline) and during HFNC therapy. The box-whisker plots show the median (horizontal line), the interquartile range (margins of box), the absolute range (vertical line) and outlier values (circle). ETCO ₂ end-tidal CO₂; HFNC high-flow nasal cannulae

Fig. 3

RR values distribution over time pre- (baseline) and during HFNC therapy. The box-whisker plots show the median (horizontal line), the interquartile range (margins of box), the absolute range (vertical line) and outlier values (circles). RR respiratory rate in breaths per minute (bpm); HFNC high-flow nasal cannulae