scholarly journals Nasogastric tube, a warning sign for high-flow nasal cannula failure in infants with bronchiolitis

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Milena Siciliano Nascimento ◽  
Danielle E. R. Quinto ◽  
Gisele C. Z. Oliveira ◽  
Celso M. Rebello ◽  
Cristiane do Prado
Keyword(s):  
Hospital Admission ◽  
Nasogastric Tube ◽  
Ventilatory Support ◽  
Study Groups ◽  
High Flow ◽  
Nasal Cannula ◽  
Warning Sign ◽  
High Flow Nasal Cannula ◽  
Therapy Failure ◽  
Oral Nutrition

Abstract High-flow nasal cannula (HFNC) therapy is routinely used in the treatment of infants with bronchiolitis. This study sought to identify markers associated with failure of HFNC therapy that serve as warnings for early staging of other ventilatory support products. A retrospective study of infants with a diagnosis of bronchiolitis, receiving HFNC and admitted to the pediatric intensive care unit from January 2016 to June 2017, was conducted. The subjects were divided into two study groups according to the success or failure of HFNC therapy. Risk factors were assessed using the following variables: age, time between hospital admission and start of HFNC, equipment model, and the need for a nasogastric tube. Eighty-one infants were studied, and 18 (21.7%) of them exhibited therapy failure. The results of the logistic models showed that the chances of failure for patients requiring a nasogastric tube during HFNC use were more likely than those for patients with oral nutrition (OR = 8.17; 95% CI 2.30–28.99; p = 0.001). The HFNC failure was not associated with the device used (OR = 1.56; 95% CI 0.54–4.52; p = 0.41), time between hospital admission and HFNC installation (OR = 1.01; 95% CI 0.98–1.03; p = 0.73), or age (OR = 0.98; 95% CI 0.82–1.17; p = 0.82). Among late outcomes evaluated, the patients with therapy failure had longer total durations of O2 use (p < 0.001) and longer hospital stays (p < 0.001). The need to use a nasogastric tube during HFNC use was associated with HFNC therapy failure and can be considered as a marker of severity in children with bronchiolitis.

scholarly journals Oral Nutrition in Children With Bronchiolitis on High-Flow Nasal Cannula Is Well Tolerated

2017 ◽  
pp. hpeds.2016-0131 ◽  
Author(s):  
Anthony Alexander Sochet ◽  
Jessica Ann McGee ◽  
Tessie Wazeerah October
Keyword(s):  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula ◽  
Oral Nutrition

scholarly journals High-flow nasal cannula therapy in a predominantly African American population with COVID-19 associated acute respiratory failure

2021 ◽  
Vol 8 (1) ◽  
pp. e000875
Author(s):  
Paul L Nguyen ◽  
Heba Osman ◽  
Donovan Watza ◽  
Suman Khicher ◽  
Aditi Sharma ◽  
...  
Keyword(s):  
African American ◽  
Patient Population ◽  
Medical Center ◽  
Multiorgan Failure ◽  
Severe Disease ◽  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula ◽  
Therapy Failure ◽  
Hospital System

ImportanceUse of non-invasive respiratory modalities in COVID-19 has the potential to reduce rates of intubation and mortality in severe disease however data regarding the use of high-flow nasal cannula (HFNC) in this population is limited.ObjectiveTo interrogate clinical and laboratory features of SARS-CoV-2 infection associated with high-flow failure.DesignWe conducted a retrospective cohort study to evaluate characteristics of high-flow therapy use early in the pandemic and interrogate factors associated with respiratory therapy failure.SettingMultisite single centre hospital system within the metropolitan Detroit region.ParticipantsPatients from within the Detroit Medical Center (n=104, 89% African American) who received HFNC therapy during a COVID-19 admission between March and May of 2020.Primary outcomeHFNC failure is defined as death or intubation while on therapy.ResultsTherapy failure occurred in 57% of the patient population, factors significantly associated with failure centred around markers of multiorgan failure including hepatic dysfunction/transaminitis (OR=6.1, 95% CI 1.9 to 19.4, p<0.01), kidney injury (OR=7.0, 95% CI 2.7 to 17.8, p<0.01) and coagulation dysfunction (OR=4.5, 95% CI 1.2 to 17.1, p=0.03). Conversely, comorbidities, admission characteristics, early oxygen requirements and evaluation just prior to HFNC therapy initiation were not significantly associated with success or failure of therapy.ConclusionsIn a population disproportionately affected by COVID-19, we present key indicators of likely HFNC failure and highlight a patient population in which aggressive monitoring and intervention are warranted.

scholarly journals High-flow nasal cannula therapy for hypoxemic respiratory failure in patients with COVID-19

2021 ◽  
Vol 8 ◽  
pp. 204993612110429
Author(s):  
Adrian Palacios Chavarria ◽  
Erika Salinas Lezama ◽  
Mauricio Gonzalez Navarro ◽  
Rafael Ricardo Valdez Vazquez ◽  
Héctor Herrera Bello ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Primary Outcome ◽  
Invasive Mechanical Ventilation ◽  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula ◽  
Therapy Failure ◽  
Hypoxemic Respiratory Failure ◽  
Respiratory Parameters ◽  
Comorbidity Index

Introduction: High-flow nasal cannula (HFNC) therapy in patients with hypoxemic respiratory failure due to COVID-19 is poorly understood and remains controversial. Methods: We evaluated a large cohort of patients with COVID-19-related hypoxemic respiratory failure at the temporary COVID-19 hospital in Mexico City. The primary outcome was the success rate of HFNC to prevent the progression to invasive mechanical ventilation (IMV). We also evaluated the risk factors associated with HFNC success or failure. Results: HFNC use effectively prevented IMV in 71.4% of patients [270 of 378 patients; 95% confidence interval (CI) 66.6–75.8%]. Factors that were significantly different at admission included age, the presence of hypertension, and the Charlson comorbidity index. Predictors of therapy failure (adjusted hazard ratio, 95% CI) included the comorbidity-age-lymphocyte count-lactate dehydrogenase (CALL) score at admission (1.27, 1.09–1.47; p < 0.01), Rox index at 1 hour (0.82, 0.7–0.96; p = 0.02), and no prior steroid treatment (0.34, 95% CI 0.19–0.62; p < 0.0001). Patients with HFNC success rarely required admission to the intensive care unit and had shorter lengths of hospital stay [19/270 (7.0%) and 15.0 (interquartile range, 11–20) days, respectively] than those who required IMV [104/108 (96.3%) and 26.5 (20–36) days, respectively]. Conclusion: Treating patients with HFNC at admission led to improvement in respiratory parameters in many patients with COVID-19.

scholarly journals Can high-flow nasal cannula reduce the risk of bronchopulmonary dysplasia compared with CPAP in preterm infants? A systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sabrina de Jesus Brito ◽  
Sabrina Pinheiro Tsopanoglou ◽  
Endi Lanza Galvão ◽  
Franciele Angelo de Deus ◽  
Vanessa Pereira de Lima
Keyword(s):  
Clinical Trials ◽  
Bronchopulmonary Dysplasia ◽  
Ventilatory Support ◽  
High Flow ◽  
Nasal Cannula ◽  
Cochrane Library ◽  
High Flow Nasal Cannula ◽  
Air Leak ◽  
Nasal Injury ◽  
Air Leak Syndrome

Abstract Background Bronchopulmonary dysplasia (BPD) is a chronic lung disease that affects the premature lung, and to reduce its incidence has been used non-invasive ventilatory support, such as continuous positive airway (CPAP) and high-flow nasal cannula (HFNC). Thus, the objective of this review was to assess whether the use of high flow nasal cannula (HFNC) compared to continuous positive airway pressure (CPAP) decreases the risk of bronchopulmonary dysplasia (BPD) in premature newborns. Methods The protocol was registered (Prospero: CRD42019136631) and the search was conducted in the MEDLINE, PEDro, Cochrane Library, CINAHL, Embase, and LILACS databases, and in the clinical trials registries, until July 2020. We included randomized clinical trials comparing HFNC versus CPAP use in premature infants born at less than 37 weeks of gestational age. The main outcome measures were the development of BPD, air leak syndrome, and nasal injury. The methodological quality of the included studies was assessed using the Cochrane risk of bias tool and the GRADE system was used to summarize the evidence recommendations. Meta-analyses were performed using software R. Results No difference was found between HFNC or CPAP for the risk of BPD (RR: 1.10; 95% CI: 0.90–1.34), air leak syndrome (RR: 1.06; 95% CI: 0.52–2.14), and nasal trauma (RR: 2.00; 95% CI: 0.64–6.25), with a very low level of evidence. Conclusion(s) The HFNC showed similar results when compared to CPAP in relation to the risk of BPD, air leak syndrome, and nasal injury. In the literature, no randomized clinical trial has been found with BPD as the primary outcome to support possible outcomes.

scholarly journals Sampling Methods and Risk Stratification Regarding Environmental Contamination by SARS-CoV-2

2021 ◽  
Vol 34 (13) ◽  
Author(s):  
Marta Mendes ◽  
Ana Andrade Oliveira ◽  
Olga Pires ◽  
Fernando Branca ◽  
Maria Beirão ◽  
...  
Keyword(s):  
Environmental Contamination ◽  
Ventilatory Support ◽  
High Flow ◽  
Nasal Cannula ◽  
Surface Contamination ◽  
Invasive Ventilation ◽  
High Flow Nasal Cannula ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Risk Zones

Introduction: Transmission of COVID-19 through close contact and droplets is well established, but the influence of aerosol and surface contamination remains to be determined. Literature is scarce and inconsistent about the viable virus particles free-distance from infected patients, as well as about different swabbing methods for surface contamination evaluation. The aim of this study was to evaluate the most sensitive method for the assessment of surface contamination, classify the likelihood of environmental contamination in risk zones and compare the environmental contamination between oxygenation and ventilatory support.Material and Methods: Swabs from potentially contaminated surfaces in a COVID-19 ward, with patients treated with different types of oxygen and ventilatory support, were collected. Three types of swabs were compared in order to evaluate the most sensitive collection method. For risk zone categorization, areas were divided according to the distance from the patient.Results: Of the 63 swabs collected, 17 (27%) tested positive for the presence of SARS-CoV-2. The highest positivity rate was observed with the sterile premoistened swab with saline (n = 8; 38%), but without statistically significant differences. The highest number of positive samples were collected from the high-risk zones, specifically those located one meter from the patient (n = 13; 48%), with statistically significant differences. Only the rooms of patients supported with non-invasive ventilation or high-flow nasal cannula had evidence of bedroom contamination, with 45% and 27% of swab positivity, with statistically significant differences.Discussion: Our findings favour the premoistened swab without transport medium for surface contamination assessment, even though without statistical differences. A statistically significant trend supporting the division in risk zones, according to the distance from the patient, was also identified. The higher positivity rate from the non-invasive ventilation and high-flow nasal cannula bedrooms suggests a significant association between ventilatory strategies and surface contamination, probably due to higher particle dispersion.Conclusion: Our findings support the use of the sterile premoistened swab without preservation medium, the classification of risk areas considering the distance from the patient, and the variability of RNA dispersion between oxygenation and ventilatory support.

High-Flow Nasal Cannula on Neonatal Transport: Table

PEDIATRICS ◽  
2016 ◽  
Vol 137 (Supplement 3) ◽  
pp. 642A-642A
Author(s):  
Vivien Carrion ◽  
Matthew Parrish ◽  
Praveen Chandrasekharan
Keyword(s):  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula ◽  
Neonatal Transport
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