scholarly journals Clinical impact of implementing humidified high-flow nasal cannula on interhospital transport among children admitted to a PICU with respiratory distress: a cohort study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Shinya Miura ◽  
Kazue Yamaoka ◽  
Satoshi Miyata ◽  
Warwick Butt ◽  
Sile Smith
Keyword(s):  
Cohort Study ◽  
Length Of Stay ◽  
Respiratory Distress ◽  
High Flow ◽  
Respiratory Support ◽  
High Flow Nasal Cannula ◽  
Post Intervention ◽  
Confidential Interval ◽  
Interhospital Transport ◽  
Retrieval Team

Abstract Background There is a limited evidence for humidified high-flow nasal cannula (HHFNC) use on inter-hospital transport. Despite this, its use during transport is increasing in children with respiratory distress worldwide. In 2015 HHFNC was implemented on a specialized pediatric retrieval team serving for Victoria. The aim of this study is to investigate the effect of the HHFNC implementation on the retrieval team on the paediatric intensive care unit (PICU) length of stay and respiratory support use. Methods We performed a cohort study using a comparative interrupted time-series approach controlling for patient and temporal covariates, and population-adjusted analysis. We studied 3022 children admitted to a PICU in Victoria with respiratory distress January 2010–December 2019. Patients were divided in pre-intervention era (2010–2014) and post-intervention era (2015–2019). Results 1006 children following interhospital transport and 2016 non-transport children were included. Median (IQR) age was 1.4 (0.7–4.5) years. Pneumonia (39.1%) and bronchiolitis (34.3%) were common. On retrieval, HHFNC was used in 5.0% (21/420) and 45.9% (269/586) in pre- and post-intervention era. In an unadjusted model, median (IQR) PICU length of stay was 2.2 (1.1–4.2) and 1.7 (0.9–3.2) days in the pre- and post-intervention era in transported children while the figures were 2.4 (1.3–4.9) and 2.1 (1.2–4.5) days in non-transport children. In the multivariable regression model, the intervention was associated with the reduced PICU length of stay (ratio 0.64, 95% confidential interval 0.49–0.83, p = 0.001) with the predicted reduction of PICU length of stay being − 10.6 h (95% confidential interval − 16.9 to − 4.3 h), and decreased respiratory support use (− 25.1 h, 95% confidential interval − 47.9 to − 2.3 h, p = 0.03). Sensitivity analyses including a model excluding less severe children showed similar results. In population-adjusted analyses, respiratory support use decreased from 4837 to 3477 person-hour per year in transported children over the study era, while the reduction was 594 (from 9553 to 8959) person-hour per year in non-transport children. With regard to the safety, there were no escalations of respiratory support mode during interhospital transport. Conclusions The implementation of HHFNC on interhospital transport was associated with the reduced PICU length of stay and respiratory support use among PICU admissions with respiratory distress.

scholarly journals Impact of High-Flow Nasal Cannula Use on Neonatal Respiratory Support Patterns and Length of Stay

2016 ◽  
Vol 61 (10) ◽  
pp. 1299-1304 ◽  
Author(s):  
Suma B Hoffman ◽  
Natalie Terrell ◽  
Colleen Hughes Driscoll ◽  
Natalie L Davis
Keyword(s):  
Length Of Stay ◽  
High Flow ◽  
Nasal Cannula ◽  
Respiratory Support ◽  
High Flow Nasal Cannula

scholarly journals Emergency Department-initiated High-flow Nasal Cannula for COVID-19 Respiratory Distress

2021 ◽  
Vol 22 (4) ◽  
pp. 979-987
Author(s):  
Zachary Jarou ◽  
David Beiser ◽  
Willard Sharp ◽  
Ravi Ravi Chacko ◽  
Deirdre Goode ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Respiratory Distress ◽  
Hospital Length ◽  
High Flow ◽  
Nasal Cannula ◽  
Hospital Length Of Stay ◽  
High Flow Nasal Cannula ◽  
Before And After ◽  
Progressive Respiratory Failure

Introduction: Patients with coronavirus disease 2019 (COVID-19) can develop rapidly progressive respiratory failure. Ventilation strategies during the COVID-19 pandemic seek to minimize patient mortality. In this study we examine associations between the availability of emergency department (ED)-initiated high-flow nasal cannula (HFNC) for patients presenting with COVID-19 respiratory distress and outcomes, including rates of endotracheal intubation (ETT), mortality, and hospital length of stay. Methods: We performed a retrospective, non-concurrent cohort study of patients with COVID-19 respiratory distress presenting to the ED who required HFNC or ETT in the ED or within 24 hours following ED departure. Comparisons were made between patients presenting before and after the introduction of an ED-HFNC protocol. Results: Use of HFNC was associated with a reduced rate of ETT in the ED (46.4% vs 26.3%, P <0.001) and decreased the cumulative proportion of patients who required ETT within 24 hours of ED departure (85.7% vs 32.6%, P <0.001) or during their entire hospitalization (89.3% vs 48.4%, P <0.001). Using HFNC was also associated with a trend toward increased survival to hospital discharge; however, this was not statistically significant (50.0% vs 68.4%, P = 0.115). There was no impact on intensive care unit or hospital length of stay. Demographics, comorbidities, and illness severity were similar in both cohorts. Conclusions: The institution of an ED-HFNC protocol for patients with COVID-19 respiratory distress was associated with reductions in the rate of ETT. Early initiation of HFNC is a promising strategy for avoiding ETT and improving outcomes in patients with COVID-19

scholarly journals Description and validation of a novel score (Flow Index) as a clinical indicator of the level of respiratory support to children on high flow nasal cannula.

2020 ◽  
Author(s):  
sandeep tripathi ◽  
Jeremy Mcgarvey ◽  
Nadia Shaikh ◽  
Logan Meixsell
Keyword(s):  
Length Of Stay ◽  
Flow Rate ◽  
Retrospective Chart Review ◽  
Maximum Flow ◽  
High Flow ◽  
Nasal Cannula ◽  
Respiratory Support ◽  
Flow Index ◽  
High Flow Nasal Cannula ◽  
Independent Association

Objective: Describe & validate flow index (FiO2×flow rate/weight) to report the degree of respiratory support to children on high flow nasal cannula (HFNC) Methods: Retrospective chart review. Children managed with HFNC from 01/01/15 to 12/31/19. Variables included in the flow index (weight, FiO2, flow rate) and outcomes (hospital and ICU length of stay [LOS], escalation to the ICU) extracted from medical records. Max flow index defined by the earliest timestamp when patients FiO2×Flow rate was maximum. Step-wise regression used to determine the relationship between outcome (length of stay and escalation to ICU) and flow index Results: 1537 patients met the study criteria. Median 1st and maximum flow index of the population 24.1 and 38.1, respectively. Both 1st and maximum flow indexes showed a significant correlation with the LOS (r 0.25 and 0.31). Correlation for the index was stronger than that of the variables used to calculate them and remained significant after controlling for age, race, sex, and diagnoses. Mild, moderate, and severe categories of 1st and max flow index derived using quartiles and showed significant age and diagnosis independent association with LOS. Patients with 1st flow index >20 and maximum flow index >59.5 had increased odds ratio of escalation to ICU (OR 2.39 and 8.08). The 1st flow index had a negative association with rapid response activation. Conclusions: Flow index is a valid measure for assessing the degree of respiratory support for children on HFNC. High flow index associated with longer hospital LOS and the risk of escalation to ICU.

scholarly journals Outcomes of Heated High Flow Nasal Cannula in Patients With Severe or Life-Threatening COVID-19 at a Military Treatment Facility—A Retrospective Cohort Study

2021 ◽  
Author(s):  
Capt Yonatan P Dollin ◽  
Capt Brian P Elliott ◽  
Ronald Markert ◽  
Maj Matthew T Koroscil
Keyword(s):  
Cohort Study ◽  
Length Of Stay ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Medical Center ◽  
High Flow ◽  
High Flow Nasal Cannula ◽  
Life Threatening ◽  
Treatment Facilities ◽  
Military Treatment Facilities

ABSTRACT Introduction The coronavirus-19 (COVID-19) pandemic has forced radical changes in management of healthcare in military treatment facilities (MTFs). Military treatment facilities serve unique patients that have a service connection; thus, research and data on this population are relatively sparse. The purpose of this study was to provide descriptive data on characteristics and outcomes of MTF patients with COVID-19 who are treated with heated high-flow nasal cannula (HHFNC). Materials and Methods We performed a single-center retrospective cohort study at the Wright-Patterson Medical Center, a 52-bed hospital in an urban setting. We received approval from our Institutional Review Board. The cohort included patients admitted from June 1, 2020, through May 15, 2021 with severe or life-threatening COVID-19 from a positive severe acute respiratory syndrome–related coronavirus 2 reverse transcription polymerase chain reaction test who were placed on HHFNC during their hospital stay. Severe disease was defined as dyspnea, respiratory rate ≥30/min, blood oxygen saturation ≤93% without supplemental oxygen, partial pressure of arterial oxygen to fraction of inspired oxygen ratio &lt;300, or lung infiltrates involving &gt;50% of lung fields within 24-48 hours. Life-threatening disease was defined as having septic shock or multiple organ dysfunction or requiring intubation. Patients meeting these criteria were retrieved from a quality improvement cohort that represents a consecutive group of patients with COVID-19 admitted to the Wright-Patterson Medical Center. Results Our MTF managed 70 cases of severe or life-threatening COVID-19 from June 1, 2020, to May 15, 2021. Of the 70 cases, 19 (27%) were placed on HHFNC. After initiation of HHFNC, median SpO2/FiO2 was 281.8 and at 24 hours 145.4. Median respiratory rate oxygenation at these times were 10.7 and 9.4, respectively. Fifty percent required mechanical ventilation during hospitalization. Median intensive care unit length of stay was 11 days, with a maximum stay of 39 days. Median hospital length of stay was 12 days, with a maximum of 39 days. Conclusion Our retrospective cohort study characterized and analyzed outcomes observed in a MTF population, with severe or life-threatening COVID-19, who were treated with HHFNC. While the study did not have the power to make concrete conclusions on the optimal form of respiratory support for COVID-19 patients, our data support HHFNC as a reasonable treatment modality despite some notable differences between our cohort and prior studied patient populations.

scholarly journals Association between preoperative respiratory support and outcomes in paediatric cardiac surgery

2019 ◽  
Vol 30 (1) ◽  
pp. 66-73
Author(s):  
Elizabeth C. Ciociola ◽  
Karan R. Kumar ◽  
Kanecia O. Zimmerman ◽  
Elizabeth J. Thompson ◽  
Melissa Harward ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Odds Ratio ◽  
Operative Mortality ◽  
Invasive Mechanical Ventilation ◽  
High Flow ◽  
Nasal Cannula ◽  
Respiratory Support ◽  
High Flow Nasal Cannula ◽  
Prolonged Length

AbstractBackground:Preoperative mechanical ventilation is associated with morbidity and mortality following CHD surgery, but prior studies lack a comprehensive analysis of how preoperative respiratory support mode and timing affects outcomes.Methods:We retrospectively collected data on children <18 years of age undergoing cardiac surgery at an academic tertiary care medical centre. Using multivariable regression, we examined the association between modes of preoperative respiratory support (nasal cannula, high-flow nasal cannula/noninvasive ventilation, or invasive mechanical ventilation), escalation of preoperative respiratory support, and invasive mechanical ventilation on the day of surgery for three outcomes: operative mortality, postoperative length of stay, and postoperative complications. We repeated our analysis in a subcohort of neonates.Results:A total of 701 children underwent 800 surgical procedures, and 40% received preoperative respiratory support. Among neonates, 243 patients underwent 253 surgical procedures, and 79% received preoperative respiratory support. In multivariable analysis, all modes of preoperative respiratory support, escalation in preoperative respiratory support, and invasive mechanical ventilation on the day of surgery were associated with increased odds of prolonged length of stay in children and neonates. Children (odds ratio = 3.69, 95% CI 1.2–11.4) and neonates (odds ratio = 8.97, 95% CI 1.31–61.14) on high-flow nasal cannula/noninvasive ventilation had increased odds of operative mortality compared to those on room air.Conclusion:Preoperative respiratory support is associated with prolonged length of stay and mortality following CHD surgery. Knowing how preoperative respiratory support affects outcomes may help guide surgical timing, inform prognostic conversations, and improve risk stratification models.

scholarly journals The Effect of the Treatment with Heated Humidified High-Flow Nasal Cannula on Neonatal Respiratory Distress Syndrome in China: A Single-Center Experience

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Ge Zheng ◽  
Xiao-qiu Huang ◽  
Hui-hui Zhao ◽  
Guo-Xing Jin ◽  
Bin Wang
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Airway Pressure ◽  
Distress Syndrome ◽  
Positive Airway Pressure ◽  
High Flow ◽  
Nasal Cannula ◽  
Respiratory Support ◽  
High Flow Nasal Cannula ◽  
Neonatal Respiratory Distress

Background. Noninvasive respiratory support is considered the optimal method of providing assistance to preterm babies with breathing problems, including nasal continuous positive airway pressure (NCPAP) and humidified high flow nasal cannula (HHHFNC). The evidence of the efficacy and safety of HHHFNC used as the primary respiratory support for respiratory distress syndrome (RDS) is insufficient in low- and middle-income countries. Objective. To investigate the effect of heated humidified high flow nasal cannula on neonatal respiratory distress syndrome compared with nasal continuous positive airway pressure. Methods. An observational cross-sectional study was performed at a tertiary neonatal intensive care unit in suburban Wenzhou, China, in the period between January 2014 and December 2015. Results. A total of 128 infants were enrolled in the study: 65 in the HHHFNC group and 63 in the NCPAP group. The respiratory support with HHHFNC was similar to that with NCPAP with regard to the primary outcome. There is no significant difference between two groups in secondary outcomes. Comparing with NCPAP group, the incidence of nasal damage was lower in HHHFNC group. Conclusions. HHHFNC is an effective and well-tolerated strategy as the primary treatment of mild to moderate RDS in preterm infants older than 28 weeks of GA.

scholarly journals The Effectiveness of the Heated Humidified High Flow Nasal Cannula as an Initial Noninvasive Respiratory Support for Preterm Infants Suffering from Respiratory Distress

2020 ◽  
pp. 1-13
Author(s):  
Sarah Mohamed Nofal ◽  
May Rabie El- Sheikh ◽  
Heba Saed El- Mahdy ◽  
Mostafa Mohamed Awny
Keyword(s):  
Birth Weight ◽  
Respiratory Distress ◽  
Preterm Infants ◽  
Median Duration ◽  
Flow Rate ◽  
High Flow ◽  
Respiratory Support ◽  
High Flow Nasal Cannula ◽  
Flow Rates ◽  
Nasal Trauma

Aims: to compare the efficacy and safety of the heated humidified high-flow nasal cannula as a noninvasive respiratory support for the initial management of respiratory distress in preterm infants ≥ 30 weeks gestation with birth weight ≥ 1300 g at different flow rates (3 L/min and 6 L/min) on admission. Study Design: A Randomized controlled trial. Place and Duration of Study: Neonatal Intensive Care Unit, Pediatrics department, Tanta University Hospitals, over one-year period, from December 2018 to December 2019. Methodology: 30 preterm neonates, with gestational ages ranged between 30 to 36 weeks and birth weight ≥ 1300 g, were randomized to receive HHHFNC at either flow rate 3 or 6 L\min as an initial respiratory support. Primary outcomes included: the incidence of treatment failure of the HHHFNC at flow 3 L/min and 6 L/min, which will require n CPAP or NIMV, or will require intubation. Secondary outcomes included: rate of deaths at any time after randomization, the total duration of all types of oxygen support and incidence of neonatal morbidities such as nasal trauma, symptomatic patent ductus arteriosus (PDA), intraventricular hemorrhage (IVH ≥ grade II), pneumothorax, pulmonary hemorrhage, retinopathy of prematurity (ROP), apnea, sepsis and necrotizing enterocolitis (NEC ≥ stage II). Results: the incidence of the need for higher flow rate of HHHFNC (n=11, 36.6%) , the need for n CPAP or NIMV after failure of higher flow rate of HHHFNC (n=11, 36.6%), the need for intubation & MV (n=1, 3.3%), the incidence of nasal trauma (n=7, 23.3%), BPD (n=0) , IVH ≥ II (n=0), NEC ≥II (n=0), pneumothorax (n=0) , the median duration of hospitalization =10 days (7-15), the median duration of all oxygen support = 6.5 days (6-7). The failure rate was 11 out of 30 infants (36.6%), no deaths or pulmonary haemorrhage. Conclusion: HHHFNC use shows similar rates of efficacy to other forms of noninvasive respiratory support in preterm infants with respiratory distress for initial respiratory support with lesser complications. There were better outcomes with higher gestational age and birth weight at either flow rates 3 or 6 L/min.

scholarly journals Comparison of high flow oxygen therapy in children with respiratory distress due to bronchiolitis and pneumonia

2021 ◽  
Author(s):  
Uday S. Surabhi ◽  
Gangasamudra Veerappa Basavaraja ◽  
Maaz Ahmed ◽  
Sujith Kumar Tummala
Keyword(s):  
Respiratory Distress ◽  
Prospective Observational Study ◽  
Primary Outcome ◽  
Pediatric Intensive Care ◽  
High Flow ◽  
Nasal Cannula ◽  
Respiratory Support ◽  
High Flow Nasal Cannula ◽  
High Flow Oxygen ◽  
Clinical Stabilization

Background: Respiratory support through high flow nasal cannula (HFNC) therapy has emerged as a new method to provide respiratory support with bronchiolitis. Aim was to study outcome of HFNC therapy in children with bronchiolitis and pneumonia.Methods: The study was a prospective observational study involving children admitted to pediatric intensive care unit with respiratory distress (RD) in the age group of 1 month to 6 years over a period of 3 months (February 2017 till April 2017). Severity was assessed by clinical respiratory score (CRS). Children with RD were initiated with high flow nasal cannula. During treatment various parameters including CRS were documented at baseline and at 15 min and then hourly in a carefully designed performa. The primary outcome was failure of HFNC and need for ventilation.Results: Sixty children were included in the study of which 22 (37%) were in the bronchiolitis group and 38 (63%) were in the pneumonia group. 38 children presented with severe RD and 19 children with moderate RD. There was significant decrease in heart rate (HR) (20%), respiratory rate (RR) (20%) and in CRS within 1 hour of HFNC with a clinical stabilization within 24 hours in 16 cases (27%), 24-48 hours in 35 cases (58%) and >48 hours in 5 (8%) cases. Therapy was successful in 55 (92%), and failed in 5 (8%).Conclusions: HFNC has better outcome in children with RD due to acute bronchiolitis when compared to pneumonia. HFNC can be safely commenced in RD in critically ill child with monitoring.

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