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G168(P) A Review of the Effectiveness of Heated, Humidified High Flow Nasal Cannula Therapy (HHHFNC) For Patients with Bronchiolitis
  1. R Rana Rahman,
  2. N Verma,
  3. P Kumar,
  4. K Eastham
  1. Department of Paediatrics, Sunderland Royal Hospital, Sunderland, UK


Introduction HHHFNC therapy is a modality of non-invasive ventilation which provides humidified, warm, high flow oxygen (>2 litres per minute). It has been proposed as an alternative to CPAP in maintaining children without the need for intubation and mechanical ventilation. We document results of HHHFNC therapy on children with bronchiolitis in our big DGH.

Aim To review the effectiveness of HHHFNC therapy for patients with bronchiolitis.

Method A retrospective study analysing records of 27 paediatric patients treated with HHHFNC therapy who presented with bronchiolitis between September 2010 – March 2011. Diagnosis of bronchiolitis was made clinically, with the aid of nasopharyngeal aspirates. Measured variables were clinical state and capillary blood gas changes; pre and 12 hours on HHHFNC. CPAP was never used on these children. Data was of normal distribution hence paired t-test was used to determine statistical significance with SPSS software.

Results 27 patients (female- 14; male- 13; mean age- 2.4 months).Single or dual bronchiolitis viruses were detected in NPA samples in addition to a H1N1 strain in 3 patients.

Mean admission was 6 days with a mean duration on HHHFNC of 3.1days and a median of 2 days. There was a mean reduction in respiratory rate count of 8.3; mean reduction in heart rate of 23.7 and pH values improved by a mean of 0.6 (CI 99% 0.7). 65% patients changed from intravenous fluids or nasogastric feeds to oral by 24 hours.

The paired t-test analyses demonstrated statistical significance for changes in values for interval of difference of pH (p value -0.016), respiration rate (p value-0.001) and heart rate (p value -0.00).

Conclusion Findings showed subjective and objective improvement in the patients’ physical variables and blood gas analyses. There are huge potentials to cost savings and clinical effectiveness with HHHFNC therapy, as there was only one transfer to paediatric intensive care unit amongst these patients. Following the conclusions drawn from this data, a further prospective study aim would be to demonstrate whether HHHFNC has superiority or non-inferiority to CPAP therapy.

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