![]() ![]() Those born prematurely or those suffering from coexisting heart disease, chronic respiratory illness, neuromuscular disease, or immunodeficiencies are the subjects with the highest risk of severe forms of BR. Although BR can be diagnosed in adults and elderly people, it is infants, particularly the youngest, that are the subjects more affected by the disease. Hospitalization may be required in up to 10% of cases, with up to 23.8% of these patients needing critical care for respiratory impairment or apnea. In the meantime, HFNC can be considered a safe and effective method to treat children with mild to moderate BR who do not respond to SOT.īronchiolitis (BR), a lower respiratory tract infection mainly caused by respiratory syncytial virus (RSV), can be very severe. The analysis of the results clearly indicates the need for multicenter studies and official guidelines. It is not established whether it can offer greater benefits compared to SOT and when and in which infants it can replace CPAP or BiPAP. An analysis of the literature showed that, despite its widespread use, the role of HFNC in preventing respiratory failure in children with BR is not precisely defined. In this narrative review, the role of HFNC to treat infants with BR is discussed. However, consistent guidelines for initiation and discontinuation of HFNC are lacking. For its simplicity, good tolerability and safety, and the good results reported in clinical studies, HFNC has become increasingly popular and is now widely used. Bi-level positive air way pressure (BiPAP), continuous positive airway pressure (CPAP), and high-flow nasal cannula (HFNC) are among them. To improve SOT and overcome the disadvantages of IMV, new measures of noninvasive and more efficient oxygen administration have been studied. Children with severe disease were intubated and treated with invasive mechanical ventilation (IMV). For years, mild BR cases were treated with noninvasive standard oxygen therapy (SOT), i.e., with cold and poorly or totally non-humidified oxygen delivered by an ambient headbox or low-flow nasal cannula. Presently, adequate nutritional support and oxygen therapy remain the only interventions recommended to treat patients with BR. The definition of HFNC, how to set flow, and aerosolized medication delivery are areas in which more research is needed.Īerosol therapy children high-flow nasal cannula pediatrics.Ĭopyright © 2018 by Daedalus Enterprises.Bronchiolitis (BR), a lower respiratory tract infection mainly caused by respiratory syncytial virus (RSV), can be very severe. Aerosols were delivered by 75% of respondents, predominantly via a vibrating mesh nebulizer placed on the dry side of the humidifier. There was no consensus on the definition of HFNC, how to set initial flow, or how to make adjustments. During aerosol therapy, 13% of respondents decreased HFNC flow, while 23% removed patients from HFNC. Aerosol therapy was delivered by 75% of respondents during HFNC, with 77% of these respondents delivering aerosol via vibrating mesh nebulizer. Noninvasive ventilation or CPAP was used by 88% of respondents as the next step for patients who failed HFNC, with 7% opting for intubation and 5% using other interventions. Initial flow was set per provider orders by 34% of respondents, per respiratory therapist-driven protocol by 28%, per patient weight by 15%, per patient age by 15% 5% of respondents used other methods. HFNC was defined as any heated gas delivered by nasal cannula by 49% of respondents, whereas 21% defined HFNC as heated gas delivered via nasal cannula at flow greater than or equal to the patient's inspiratory demand, and 16% defined HFNC as any gas delivered via nasal cannula above predefined thresholds. There were 63 responses, of which 98% used HFNC. Paper versions of the survey were also distributed at the annual Children Hospitals Association meeting. The goal of this study was to evaluate current HFNC practice by surveying practicing pediatric respiratory therapists.Ī survey instrument was posted on the American Association for Respiratory Care's AARConnect online social media platform in March 2017. ![]() In non-neonatal pediatric patients, there are limited data available to guide HFNC use, and clinical practice may vary significantly. High-flow nasal cannula (HFNC) use has greatly increased in recent years. ![]()
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