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A comparison between high‐flow nasal cannula and noninvasive ventilation in the management of infants and young children with acute bronchiolitis in the PICU
Author(s) -
Habra Basel,
Janahi Ibrahim A.,
Dauleh Hajer,
Chandra Prem,
Veten Ahmed
Publication year - 2020
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.24553
Subject(s) - medicine , nasal cannula , bronchiolitis , continuous positive airway pressure , positive airway pressure , anesthesia , pediatric intensive care unit , mechanical ventilation , ventilation (architecture) , respiratory failure , intubation , cannula , respiratory system , intensive care medicine , surgery , obstructive sleep apnea , mechanical engineering , engineering
Abstract Background Different modalities of noninvasive respiratory support have been recommended for the management of acute bronchiolitis in the pediatric intensive care unit (PICU). High‐flow nasal cannula (HFNC) is among the new modalities that have been widely used in the last decade. Methods This is a retrospective study involving infants and young children between the ages of 1 month and 2 years during the respiratory season of 2016‐2017 (October‐May). We compared the failure rate of HFNC with the failure rates of bi‐level positive airway pressure (BiPAP) vs continuous positive airway pressure (CPAP) in the management of acute bronchiolitis in the PICU. Failure was defined as a change to another respiratory support modality or endotracheal intubation and mechanical ventilation. Results One hundred thirty‐seven patients met the inclusion criteria, of which 77 patients needed HFNC, 10 needed CPAP, and 50 were on BiPAP. Among baseline characteristics, there were significant variations in age among the three groups. HFNC had a higher failure rate compared with the other two noninvasive ventilation modalities (50.6% for HFNC [n = 39 out of 77] vs 0% for CPAP [n = 0 out of 10] vs 8% for BiPAP [n = 4 out of 50], P < .01). Among the 39 patients who failed HFNC, 90% were successfully shifted to BiPAP and weaned off later, whereas the other 4 were intubated and required mechanical ventilation. However, all four patients who failed BiPAP were intubated and mechanically ventilated. No respiratory complications or mortalities were reported in the three groups. No differences were observed among the three groups in terms of the lengths of PICU or hospital stays. Conclusions We observed a higher failure rate of HFNC compared with BiPAP or CPAP in the management of infants and children with acute bronchiolitis in the PICU. Further prospective randomized trials are recommended to confirm this finding.