scholarly journals The Cost‑utility of Early use of High-flow Nasal Cannula in Bronchiolitis

2020 ◽  
Author(s):  
Jefferson Antonio Buendia ◽  
Ranniery Acuña-Cordero ◽  
Carlos E. Rodriguez-Martinez
Keyword(s):  
Cost Effectiveness ◽  
High Flow ◽  
Nasal Cannula ◽  
Pediatric Care ◽  
Base Case ◽  
Control Group ◽  
Emergency Setting ◽  
High Flow Nasal Cannula ◽  
Early Use ◽  
The Cost

Abstract Background: High-flow nasal cannula (HFNC) oxygen is a non-invasive ventilation system that was introduced as an alternative to CPAP (continuous positive airway pressure), with a marked increase in its use in pediatric care settings .This study aimed to evaluate the cost-effectiveness of early use of HFNC compared to oxygen by nasal cannula in an infant with bronchiolitis in the emergency setting. Methods: A decision tree model was used to estimate the cost-effectiveness of HFNC compared with oxygen by nasal cannula (control strategy) in an infant with bronchiolitis in the emergency setting. Cost data were obtained from a retrospective study on bronchiolitis from tertiary centers in Rionegro, Colombia, while utilities were collected from the literature. Results:The QALYs per patient calculated in the base-case model were 0.9141 (95% CI 0.913- 0.915) in the HFNC and 0.9105 (95% CI 0.910- 0.911) in control group. The cost per patient was US$368 (95% CI US$ 323- 411) in HFNC and US$441 (95% CI US$ 384-498) per patient in the control group.Conclusions: HFNC in emergency settings was cost-effective for the hospital treatment of an infant with bronchiolitis

scholarly journals The cost-utility of early use of high-flow nasal cannula in bronchiolitis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jefferson Antonio Buendía ◽  
Ranniery Acuña-Cordero ◽  
Carlos E. Rodriguez-Martinez
Keyword(s):  
Cost Effectiveness ◽  
High Flow ◽  
Nasal Cannula ◽  
Pediatric Care ◽  
Control Group ◽  
Emergency Setting ◽  
High Flow Nasal Cannula ◽  
Use Of Resources ◽  
Early Use ◽  
The Cost

Abstract Background High-flow nasal cannula (HFNC) oxygen is a non-invasive ventilation system that was introduced as an alternative to CPAP (continuous positive airway pressure), with a marked increase in its use in pediatric care settings. This study aimed to evaluate the cost-effectiveness of early use of HFNC compared to oxygen by nasal cannula in an infant with bronchiolitis in the emergency setting. Methods A decision tree model was used to estimate the cost-effectiveness of HFNC compared with oxygen by nasal cannula (control strategy) in an infant with bronchiolitis in the emergency setting. Cost data were obtained from a retrospective study on bronchiolitis from tertiary centers in Rionegro, Colombia, while utilities were collected from the literature. Results The QALYs per patient calculated in the base-case model were 0.9141 (95% CI 0.913–0.915) in the HFNC and 0.9105 (95% CI 0.910–0.911) in control group. The cost per patient was US$368 (95% CI US$ 323–411) in HFNC and US$441 (95% CI US$ 384–498) per patient in the control group. Conclusions HFNC was cost-effective HFNC compared to oxygen by nasal cannula in an infant with bronchiolitis in the emergency setting. The use of this technology in emergency settings will allow a more efficient use of resources, especially in low-resource countries with high prevalence of bronchiolitis .

scholarly journals Development in PaCO2 over 12 months in patients with COPD with persistent hypercapnic respiratory failure treated with high-flow nasal cannula—post-hoc analysis from a randomised controlled trial

2020 ◽  
Vol 7 (1) ◽  
pp. e000712
Author(s):  
Line Hust Storgaard ◽  
Hans-Ulrich Hockey ◽  
Ulla Møller Weinreich
Keyword(s):  
Hospital Admissions ◽  
Blood Gases ◽  
High Flow ◽  
Nasal Cannula ◽  
Control Group ◽  
High Flow Nasal Cannula ◽  
Exacerbation Rate ◽  
Post Hoc Analysis ◽  
Post Hoc

IntroductionPersistent hypercapnic failure in chronic obstructive pulmonary disease (COPD) is associated with poor prognosis. Long-term home non-invasive ventilation is recommended for patients with PaCO2 >7.0 kPa. Domiciliary high-flow nasal cannula (HFNC) reduces PaCO2 in short-term studies. This post-hoc analysis examines the effect of HFNC on PaCO2 levels, exacerbations and admissions in patients with COPD with persistent hypercapnic and hypoxic failures.MethodsThe original trial included 74 long-term oxygen-treated patients (31 HFNC treated/43 controls) with persistent hypercapnic failure (PaCO2 >6 kPa) who completed the 12-month study period. Baseline data included age, sex, blood gases, exacerbations and hospital admissions in the previous year. Data on blood gases were also recorded at 6 and 12 months for all patients. In addition, acute changes in blood gases after 30 min of HFNC use at site visits were examined, as were exacerbations and hospital admissions during study.ResultsPatients were comparable at baseline. After 12 months there was a 1.3% decrease in PaCO2 in patients using HFNC and a 7% increase in controls before HFNC use on site (p=0.003). After 30 min of HFNC at visits PaCO2 changed significantly, with comparable reductions, at 0, 6 and 12 months, including for controls who tried HFNC at study end (p<0.001). The exacerbation rate increased, compared with 12 months prestudy, by 2.2/year for controls (p<0.001) and 0.15/year for HFNC-treated patients (p=0.661). Hospital admission rates increased in the control group,+0.3/year from prestudy (p=0.180), And decreased by 0.67/year (p=0.013)for HFNC-treated patients.ConclusionThis post-hoc analysis indicates that HFNC stabilises patients with COPD with persistent hypoxic and hypercapnic failures, in terms of PaCO2, exacerbations and number of hospitalisations, whereas those not receiving HFNC worsened. This suggests that HFNC is a possible treatment for patients with persistent hypercapnic COPD.

scholarly journals Effect of post-extubation high-flow nasal cannula on reintubation in elderly patients: a retrospective propensity score-matched cohort study

2020 ◽  
Vol 14 ◽  
pp. 175346662096849
Author(s):  
Ryoung-Eun Ko ◽  
Chul Park ◽  
Jimyoung Nam ◽  
Myeong Gyun Ko ◽  
Soo Jin Na ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Propensity Score ◽  
Elderly Patients ◽  
Oxygen Therapy ◽  
High Flow ◽  
Nasal Cannula ◽  
Control Group ◽  
High Flow Nasal Cannula ◽  
Mechanically Ventilated ◽  
Clinical Benefits

Background: Studies of mechanically ventilated patients with a low risk of reintubation have suggested that the use of high-flow nasal cannula (HFNC) oxygen therapy reduces the risk of reintubation compared with conventional oxygen therapy (COT). However, the effect of HFNC following extubation in elderly patients with a high risk of reintubation remains unclear. Methods: All consecutive medical intensive care unit (ICU) patients aged >65 years who were mechanically ventilated for >24 h were prospectively registered between July 2017 and June 2018. Control was obtained from a historical database of patients attending the same ICU from January 2012 to December 2013. A total of 152 patients who underwent HFNC after planned extubation according to institutional protocols (HFNC group) were compared with a propensity-matched historical control group who underwent COT ( n = 175, COT group). The primary outcome was the proportion of reintubated patients within 48 h after planned extubation. Results: One hundred patients from the HFNC group and 129 patients from the COT group were matched by a propensity score that reflected the probability of receiving HFNC, and all variables were well matched. Post-extubation respiratory failure (41.0% versus 33.3%, p = 0.291) and reintubation rate within 48 h (16.0% versus 11.6%, p = 0.436) did not differ between the HFNC and COT groups. However, decreased levels of consciousness as a sign of post-extubation respiratory failure (27.0% versus 11.7%, p = 0.007) were significantly increased in the HFNC group compared with the COT group. Conclusion: Among elderly patients who underwent planned extubation, HFNC was not associated with a decrease in the risk of reintubation. Further prospective study evaluating the clinical benefits of post-extubation HFNC in elderly patients is needed. The reviews of this paper are available via the supplemental material section.

1016: EARLY USE OF HIGH-FLOW NASAL CANNULA FOR HYPOXEMIC RESPIRATORY FAILURE IN THE ICU PATIENT

2016 ◽  
Vol 44 (12) ◽  
pp. 330-330
Author(s):  
Keith Lamb ◽  
Matthew Trump ◽  
Trevor Oetting ◽  
Julie Jackson ◽  
David Blake ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula ◽  
Hypoxemic Respiratory Failure ◽  
Early Use

scholarly journals Should the Pendulum Swing Back? More Transfers to the ICU After Implementing Ward-Based High-Flow Nasal Cannula Initiation Protocols for Bronchiolitis

10.12788/3462 ◽  
2020 ◽  
Vol 15 (6) ◽  
pp. 381-382
Author(s):  
Daniel J Sklansky ◽  
Sanjay Mahant
Keyword(s):  
Oxygen Therapy ◽  
Work Of Breathing ◽  
High Flow ◽  
Nasal Cannula ◽  
Large Trial ◽  
High Flow Nasal Cannula ◽  
Pendulum Swing ◽  
Weak Evidence ◽  
Early Use ◽  
The One

As an appealing, physiologically plausible treatment, humidified oxygen delivery via high-flow nasal cannula (HFNC) has been rapidly adopted for the treatment of bronchiolitis despite weak evidence supporting its routine and early use in hypoxemic infants.1 Although HFNC use has been associated with decreased work of breathing and lower rates of progression to invasive ventilation in some studies, the one large trial published on the topic found no difference between early HFNC and standard oxygen therapy on length of stay in hospital, duration of oxygen therapy, or rates of intubation.2,3 No adequately powered studies have examined the effect of ward-based HFNC initiation on ICU transfer, an outcome that it is designed to prevent.

scholarly journals A randomised trial of high-flow nasal cannula in infants with moderate bronchiolitis

2020 ◽  
Vol 56 (1) ◽  
pp. 1901926 ◽  
Author(s):  
Philippe Durand ◽  
Tamma Guiddir ◽  
Christèle Kyheng ◽  
Florence Blanc ◽  
Olivier Vignaud ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Controlled Trial ◽  
Randomised Trial ◽  
High Flow ◽  
Nasal Cannula ◽  
Respiratory Support ◽  
Control Group ◽  
Study Group ◽  
High Flow Nasal Cannula ◽  
Significant Difference

BackgroundThe objective was to determine whether high-flow nasal cannula (HFNC), a promising respiratory support in infant bronchiolitis, could reduce the proportion of treatment failure requiring escalation of care.MethodsIn this randomised controlled trial, we assigned infants aged <6 months who had moderate bronchiolitis to receive either HFNC at 3 L·kg−1·min−1 or standard oxygen therapy. Crossover was not allowed. The primary outcome was the proportion of patients in treatment failure requiring escalation of care (mostly noninvasive ventilation) within 7 days following randomisation. Secondary outcomes included rates of transfer to the paediatric intensive care unit (PICU), oxygen, number of artificial nutritional support-free days and adverse events.ResultsThe analyses included 268 patients among the 2621 infants assessed for inclusion during two consecutive seasons in 17 French paediatric emergency departments. The percentage of infants in treatment failure was 14% (19 out of 133) in the study group, compared to 20% (27 out of 135) in the control group (OR 0.66, 95% CI 0.35–1.26; p=0.21). HFNC did not reduce the risk of admission to PICU (21 (15%) out of 133 in the study group versus 26 (19%) out of 135 in the control group) (OR 0.78, 95% CI 0.41–1.41; p=0.45). The main reason for treatment failure was the worsening of modified Wood clinical asthma score (m-WCAS). Short-term assessment of respiratory status showed a significant difference for m-WCAS and respiratory rate in favour of HFNC. Three pneumothoraces were reported in the study group.ConclusionsIn patients with moderate bronchiolitis, there was no evidence of lower rate of escalating respiratory support among those receiving HFNC therapy.

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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