Volume 30, Issue 141 (July & August 2022)                   J Adv Med Biomed Res 2022, 30(141): 340-346 | Back to browse issues page

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Durán Ochoa N, Edel Nudelman T, Mulett Hoyos H, Bastidas A, Diaz Ritter C A, Fernández-Sarmiento J. Description of the Clinical Course and Severity Score Progression in Critically Ill Children with Acute Bronchiolitis on High-Flow Nasal Cannula Support. J Adv Med Biomed Res 2022; 30 (141) :340-346
URL: http://journal.zums.ac.ir/article-1-6518-en.html
Description of the Clinical Course and Severity Score Progression in Critically Ill Children with Acute Bronchiolitis on High-Flow Nasal Cannula Support
Nelson Durán Ochoa1 , Tammy Edel Nudelman2 , Hernando Mulett Hoyos3 , Alirio Bastidas4 , Cesar A Diaz Ritter5 , Jaime Fernández-Sarmiento 6
1- Dept. of Pediatrics, University of La Sabana (Universidad de La Sabana), Bogotá, Colombia
2- Dept. of Pediatric Critical Care. Fundación Cardioinfantil, Bogotá, Colombia
3- Dept. of Research, University of La Sabana (Universidad de La Sabana), Bogotá, Colombia
4- Dept. of Research, University of la Sabana, Bogotá, Colombia
5- Dept. of Pediatrics, University of La Sabana, Bogotá, Colombia
6- Dept. of Pediatrics, University of La Sabana, Bogotá, Colombia , jaimefe@unisabana.edu.co
Abstract:   (60114 Views)

Background and Objective: Bronchiolitis is one of the main causes of morbidity and mortality in children. High-flow nasal cannulas (HFNCs) are an alternative for managing moderate to severe cases. Our aim was to describe the outcomes in critically ill children with bronchiolitis who receive HFNC support.
Materials and Methods: This was a retrospective cohort study of critically ill children who had bronchiolitis and received HFNC support while hospitalized in the pediatric intensive care unit (PICU) between January 2013 and January 2020. The primary outcome was deterioration in the Wood-Downes scale. Secondary outcomes included length of hospitalization, duration of oxygen therapy, SpO2/FiO2, and the ROX index (respiratory rate – oxygenation).
Results: During this period, 2,390 children were admitted, 87 of whom had bronchiolitis and met the inclusion criteria. The median age was 4.4 months (IQR: 2.4 – 8.6). In 87.3% of cases there was no worsening in the scale with the use of HFNCs. In the group that worsened, 79.3% had moderate and 20.7% severe bronchiolitis on admission, and they had a higher rate of congenital heart disease (p=0.03), chronic respiratory diseases (p=0.03) and neurological (p=0.05) diseases. At 12 hours, this group had a lower SpO2/FiO2 (< 180) and ROX index (< 4.0). None of the patients required mechanical ventilation.
Conclusion: The use of HFNCs in children with moderate to severe bronchiolitis was associated with a modified clinical course, avoiding mechanical ventilation even in risk groups. SpO2/FiO2 and ROX index 12-hour cut-off points suggestive of patients with a delayed response to HFNC support were identified.

Keywords: Bronchiolitis, High-flow nasal cannula, Pediatric intensive care, Treatment, Wood-Downes
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✅ The use of HFNCs in children with moderate to severe bronchiolitis was associated with a modified clinical course, avoiding mechanical ventilation even in risk groups. SpO2/FiO2 and ROX index 12-hour cut-off points suggestive of patients with a delayed response to HFNC support were identified.


Type of Study: Original Article | Subject: Clinical medicine
Received: 2021/04/24 | Accepted: 2021/10/11 | Published: 2022/06/30
References
1. Kou M, Hwang V, Ramkellawan N. Bronchiolitis: from practice guideline to clinical practice. Emerg Med Clin North Am. 2017;36(2):275-86. [DOI:10.1016/j.emc.2017.12.006] [PMID]
2. Ghazaly M, Nadel S. Overview of prevention and management of acute bronchiolitis due to respiratory syncytial virus. Expert Rev Anti Infect Ther. 2018;16(12):913-28. [DOI:10.1080/14787210.2018.1543589] [PMID]
3. Estrada N, Vesga P, Restrepo J. Bronquiolitis: una perspectiva actual. Pediatr Integr. 2017;8(1):49-56.
4. Guo C, Sun X, Wang X, Guo Q, Chen D. Network meta-analysis comparing the efficacy of therapeutic treatments for bronchiolitis in children.J Parenter Enter Nutr.2018;42(1):186-95.
5. Beggs S, Wong ZH, Kaul S, Ogden KJ, Walters JAE. High-flow nasal cannula therapy for infants with bronchiolitis. Cochrane database Syst Rev.2014;(1):CD009609. [DOI:10.1002/14651858.CD009609.pub2] [PMID]
6. Fainardi V, Abelli L, Muscarà M, Pisi G, Principi N, Esposito S. Update on the role of high flow nasal cannula in infants with bronchiolitis. Children. 2021;8(66):1-12. [DOI:10.3390/children8020066] [PMID] [PMCID]
7. NICE Guidelines. Bronchiolitis in children : diagnosis and management. 2015;(NG9):1-21.
8. Wood DW, Downes JJ, Lecks HI. A clinical scoring system for the diagnosis of respiratory failure: preliminary report on childhood status asthmaticus. Am J Dis Child 1972;123(3):227-8. [DOI:10.1001/archpedi.1972.02110090097011] [PMID]
9. Vásquez-Hoyos P, Jiménez-Chaves A, Tovar-Velásquez M,et al. Factors associated to high-flow nasal cannula treatment failure in pediatric patients with respiratory failure in two pediatric intensive care units at high altitude. Med Intensiva. 2019;45(4):195-204. [DOI:10.1016/j.medin.2019.10.005] [PMID]
10. Morosini F, Machado K, Rompani E, Taboada R, Castelli X. Noninvasive ventilation and high-flow oxygen therapy in children in moderate care wards. Experience in the Special Acute Respiratory Care Unit of the CHPR Pediatric Hospital during 2013-2016. Arch Pediatr Urug. 2018;89(2):78-85.
11. Sztrymf B, Messika J, Mayot T, Lenglet H, Dreyfuss D, Ricard JD. Impact of high-flow nasal cannula oxygen therapy on intensive care unit patients with acute respiratory failure: A prospective observational study. J Crit Care. 2012;27(3):324.e9-324.e13. [DOI:10.1016/j.jcrc.2011.07.075] [PMID]
12. Frat JP, Thille AW, Mercat A, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med 2015; 372 (23):2185-96. [DOI:10.1056/NEJMoa1503326] [PMID]
13. Riese J, Porter T, Fierce J, et al.Clinical outcomes of bronchiolitis after implementation of a general ward high flow nasal cannula guideline.Hosp Pediatr. 2017;7(4):197-203. [DOI:10.1542/hpeds.2016-0195] [PMID]
14. Franklin D, Dalziel S, Schlapbach LJ, et al. Early high flow nasal cannula therapy in bronchiolitis, a prospective randomised control trial (protocol): A paediatric acute respiratory intervention study (PARIS). BMC Pediatr. 2015;15(183):1-8. [DOI:10.1186/s12887-015-0501-x] [PMID] [PMCID]
15. Roca O, Messika J, Caralt B, et al. Predicting success of high-flow nasal cannula in pneumonia patients with hypoxemic respiratory failure:The utility of the ROX index. J Crit Care. 2016;35:200-5. [DOI:10.1016/j.jcrc.2016.05.022] [PMID]
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