Original Article
High Flow Nasal Cannulae Therapy in Infants with Bronchiolitis

https://doi.org/10.1016/j.jpeds.2009.10.039Get rights and content

Objectives

To determine whether the introduction of heated humidified high-flow nasal cannulae (HFNC) therapy was associated with decreased rates of intubation for infants <24 months old with bronchiolitis admitted to a pediatric intensive care unit (PICU).

Study design

A retrospective chart review of infants with bronchiolitis admitted before and in the season after introduction of HFNC.

Results

In the season after the introduction of HFNC, only 9% of infants admitted to the PICU with bronchiolitis required intubation, compared with 23% in the prior season (P=.043). This 68% decrease in need for intubation persisted in a logistic regression model controlling for age, weight, and RSV status. HFNC therapy resulted in a greater decrease in respiratory rate compared with other forms of respiratory support, and those infants with the greatest decrease in respiratory rate were least likely to be intubated. In addition, median PICU length of stay for children with bronchiolitis decreased from 6 to 4 days after the introduction of HFNC.

Discussion

We hypothesize that HFNC decreases rates of intubation in infants with bronchiolitis by decreasing the respiratory rate and work of breathing by providing a comfortable and well-tolerated means of noninvasive ventilatory support.

Section snippets

Methods

The Fisher Paykel heated HFNC system (MR850 humidification system; Fisher & Paykel Healthcare) became available at our institution in September 2006. Low-resistance nasal cannulae available included the infant cannulae with a maximum flow rate of 7 L/min and the pediatric cannulae with a maximum flow rate of 8 L/min. Most of the infants in this study were admitted to the PICU from the emergency department or were transferred to the PICU from the general pediatrics unit. HFNC oxygen therapy was

Results

One hundred fifteen infants met all of the inclusion and none of the exclusion criteria and were included in the analysis, 57 from before the introduction of HFNC (2005–2006, HFNC-NA group) and 58 from the season after the introduction of HFNC (2006–2007, HFNC-A group). The age, weight, gestational age, sex, RSV status, and Pediatric Index of Mortality 216 score were similar between the two groups (Table I). More children in the HFNC-NA group had a history of prematurity, defined as a

Discussion

In this retrospective chart review, infants < 24 months of age who presented to the PICU with bronchiolitis demonstrated a 68% decrease in need for intubation with the introduction of HFNC therapy. This difference is unlikely to be explained by other patient characteristics, because the groups were similar at baseline. In addition, the difference persisted in a logistic regression controlling for age, weight, RSV status, and gestational age. External factors other than the introduction of HFNC

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The authors declare no conflicts of interest.

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