What is the optimal flow on starting high-flow oxygen therapy for bronchiolitis treatment in paediatric wards?

Introduction: High-flow nasal cannula (HFNC) is a safe and effective treatment in bronchiolitis in paediatric wards. The optimal flow on starting HFNC is still unknown. The main aim of this study was to determine if there were differences in clinical outcome of patients according the initial flow. M...

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Main Authors: Felipe González Martínez, María Isabel González Sánchez, Jimena Pérez-Moreno, Blanca Toledo del Castillo, Rosa Rodríguez Fernández
Format: Article
Language:Spanish
Published: Elsevier 2019-08-01
Series:Anales de Pediatría (English Edition)
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Online Access:http://www.sciencedirect.com/science/article/pii/S2341287919301061
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Summary:Introduction: High-flow nasal cannula (HFNC) is a safe and effective treatment in bronchiolitis in paediatric wards. The optimal flow on starting HFNC is still unknown. The main aim of this study was to determine if there were differences in clinical outcome of patients according the initial flow. Methods: A prospective, observational and analytical study was conducted between 2014 and 2016 on infants admitted with bronchiolitis and who required HFNC. Two cohorts were established according to the initial flow: cohort 1: flow 15 L/min (HFNC-15), and cohort 2: flow 10 L/min (HFNC-10). Treatment failure was defined as the presentation of apnoea or the absence of clinical improvement in the first 12–24 h. Multivariate probabilistic models were built to identify predictive variables of treatment failure. Results: A total of 57 patients were included. The median age was 4 months (IQR 2–13), and 54% received treatment with HFNC-10 and 46% with HFNC-15. In HFNC-15 cohort, respiratory rate (RR) decreased in the first hour, and in the HFNC-10 cohort in the first 6 h (P = .03). In HFNC-10 cohort, treatment failure rate was 71%, compared to 15% of HFNC-15 (P < .01). Admission to PICU was required in 35% of the HFNC-10 group vs 18% in HFNC-15 (P = .11). No adverse effects were found. Conclusions: The use of HFNC 15 L/min in bronchiolitis treatment in paediatric wards is safe and effective, achieves a faster improvement of respiratory rate and has a lower treatment failure rate. Resumen: Introducción: La oxigenoterapia de alto flujo (OAF) es un tratamiento seguro y eficaz de la bronquiolitis en las plantas de hospitalización. Se desconoce cuál es el flujo óptimo para iniciar esta terapia. Nuestro objetivo es analizar si hay diferencias en la evolución de los pacientes según el flujo inicial empleado. Métodos: Durante el periodo 2014-2016 se realizó un estudio clínico observacional y analítico de cohortes prospectivas en lactantes ingresados por bronquiolitis que precisaron OAF. Se establecieron dos cohortes en función del flujo inicial: cohorte 1: flujo 15 l/min (OAF-15); cohorte 2: flujo 10 l/min (OAF-10). El fracaso terapéutico se definió como la presentación de pausas de apnea o a la ausencia de mejoría clínica en las siguientes 12-24 h. Se construyeron modelos probabilísticos multivariantes para identificar variables predictivas de fracaso terapéutico. Resultados: Se incluyeron 57 pacientes. Mediana de edad, 4 meses (RIQ 2-13). Recibieron tratamiento con OAF-10 el 54% y con OAF-15 el 46%. En la cohorte OAF-15 la frecuencia respiratoria empezó a disminuir en la primera hora y en la cohorte OAF-10 a partir de las 6 primeras horas (p = 0,03). En la cohorte OAF-10 ocurrió fracaso terapéutico en el 71%, frente al 15% de la OAF-15 (p < 0,01). Precisaron ingreso en la UCIP el 35%, en la cohorte OAF-10 vs el 18% en la OAF-15 (p = 0,11). No se encontraron efectos adversos en ninguna de las cohortes. Conclusiones: La OAF a 15 l/min en el tratamiento de la bronquiolitis es segura y eficaz, consigue una mejoría precoz de la frecuencia respiratoria y tiene un menor porcentaje de fracaso terapéutico.
ISSN:2341-2879