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Question 1: Is there a role for high-flow nasal cannula oxygen therapy to prevent endotracheal intubation in children with viral bronchiolitis?
  1. Martin C J Kneyber1,2
  1. 1 Department of Paediatrics, Division of Paediatric Intensive Care, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
  2. 2 Critical Care, Anaesthesiology, Peri-operative medicine and Emergy medicine (CAPE), University of Groningen, Groningen, The Netherlands
  1. Correspondence to Dr Martin C J Kneyber, Department of Paediatrics, Division of Paediatric Intensive Care, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Huispost CA 80, P.O. Box 30.001, Groningen 9700 RB, The Netherlands; m.c.j.kneyber{at}umcg.nl

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Scenario

A 3-month-old previously healthy baby presented with signs and symptoms of viral bronchiolitis. He suffered from tachypnoea (respiratory rate 70 breaths/min) and hypoxaemia (transcutaneously measured oxygen saturation (SpO2) of 89% at room air). Capillary blood gas analysis revealed a moderate hypercapnia (pCO2 of 60 mm Hg). The baby was admitted to the paediatric ward. The senior consultant ordered the use of low-flow oxygen therapy, but the junior consultant argued that high-flow nasal cannula (HFNC) oxygen therapy would be preferable as it improves patient comfort and might even prevent the need for endotracheal intubation.

Structured clinical question

In children with acute respiratory distress (patient), does HFNC oxygen therapy (intervention) reduce the need for endotracheal intubation (outcome) compared with conventional oxygen supplementation (control)?

Search strategy and outcome

PubMed was searched from inception until May 2013 using the following keywords: (children OR infants) AND (high flow OR high-flow) nasal (cannula OR prong). The search was limited to children aged 0–18 years and the English language. Studies including prematurely born infants with a gestational age corrected for postconceptional age less than 40 weeks were excluded. This resulted in 57 articles. Four articles were relevant to the search question, of which one was a review article. Related links and references in the selected articles were reviewed. A search of the Cochrane library …

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