High flow nasal cannula oxygen therapy in the treatment of acute bronchiolitis in neonates

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• 作者：Lorena Bermú ; dez Barrezueta ; ^{bermudezlorena@hotmail.com} ; ^{bermudezlorena2@gmail.com} ; Nuria Garcí ; a Carbonell ; Jorge Ló ; pez Montes ; Rafael Gó ; mez Zafra ; Purificació ; n Marí ; n Reina ; Jana Herrmannova ; Javier Casero Soriano
• 关键词：High flow nasal cannula oxygen therapy ; Neonates ; Bronchiolitis ; Invasive mechanical ventilation ; Non-invasive mechanical ventilation
• 刊名：Anales de Pediatría (English Edition)
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：86
• 期：1
• 页码：37-44
• 全文大小：1172 K
• 卷排序：86

文摘

To determine whether the availability of heated humidified high-flow nasal cannula (HFNC) therapy was associated with a decrease in need for mechanical ventilation in neonates hospitalised with acute bronchiolitis.MethodsA combined retrospective and prospective (ambispective) cohort study was performed in a type II-B Neonatal Unit, including hospitalised neonates with acute bronchiolitis after the introduction of HFNC (HFNC-period; October 2011–April 2015). They were compared with a historical cohort prior to the availability of this technique (pre-HFNC; January 2008–May 2011). The need for mechanical ventilation between the two study groups was analysed. Clinical parameters and technique-related complications were evaluated in neonates treated with HFNC.ResultsA total of 112 neonates were included, 56 after the introduction of HFNC and 56 from the period before the introduction of HFNC. None of the patients in the HFNC-period required intubation, compared with 3.6% of the patients in the pre-HFNC group. The availability of HFNC resulted in a significant decrease in the need for non-invasive mechanical ventilation (30.4% vs 10.7%; P = .01), with a relative risk (RR) of .353 (95% CI: .150–.829), an absolute risk reduction (ARR) of 19.6% (95% CI: 5.13–34.2), yielding a NNT of 5. In the HFNC-period, 22 patients received high flow therapy, and 22.7% (95% CI: 7.8–45.4) required non-invasive ventilation. Treatment with HFNC was associated with a significant decrease in heart rate (P = .03), respiratory rate (P = .01), and an improvement in the Wood-Downes-Férres score (P = .00). No adverse effects were observed.ConclusionsThe availability of HFNC reduces the need for non-invasive mechanical ventilation, allowing a safe and effective medical management of neonates with acute bronchiolitis.