Log in | Register

Reduced intubation rates for infants after introduction of high-flow nasal prong oxygen delivery

A. Schibler| T. M. T. Pham| K. R. Dunster| K. Foster| A. Barlow| K. Gibbons| J. L. Hough
Pediatric Original
Volume 37, Issue 5 / May , 2011

Pages 847 - 852

Abstract

Purpose

To describe the change in ventilatory practice in a tertiary paediatric intensive care unit (PICU) in the 5-year period after the introduction of high-flow nasal prong (HFNP) therapy in infants <24 months of age. Additionally, to identify the patient subgroups on HFNP requiring escalation of therapy to either other non-invasive or invasive ventilation, and to identify any adverse events associated with HFNP therapy.

Methods

The study was a retrospective chart review of infants <24 months of age admitted to our PICU for HFNP therapy. Data was also extracted from both the local database and the Australian New Zealand paediatric intensive care (ANZPIC) registry for all infants admitted with bronchiolitis.

Results

Between January 2005 and December 2009, a total of 298 infants <24 months of age received HFNP therapy. Overall, 36 infants (12%) required escalation to invasive ventilation. In the subgroup with a primary diagnosis of viral bronchiolitis (n = 167, 56%), only 6 (4%) required escalation to invasive ventilation. The rate of intubation in infants with viral bronchiolitis reduced from 37% to 7% over the observation period corresponding with an increase in the use of HFNP therapy. No adverse events were identified with the use of HFNP therapy.

Conclusion

HFNP therapy has dramatically changed ventilatory practice in infants <24 months of age in our institution, and appears to reduce the need for intubation in infants with viral bronchiolitis.

Keywords

References

  1. Frey B, Shann F (2003) Oxygen administration in infants. Arch Dis Child 88:F84–F88
    • View reference on publisher's website
  2. Reid LM (1984) Lung growth in health and disease. Br J Dis Chest 78:113–134
    • View reference on PubMed
    • View reference on publisher's website
  3. Thorsteinsson A, Werner O, Jonmarker C, Larsson A (2002) Airway closure in anesthetized infants and children: influence of inspiratory pressures and volumes. Acta Anaesthesiol Scand 46:529–536
    • View reference on PubMed
    • View reference on publisher's website
  4. Klein M, Reynolds LG (1986) Relief of sleep-related oropharyngeal airway obstruction by continuous insufflation of the pharynx. Lancet 1:935–939
    • View reference on PubMed
    • View reference on publisher's website
  5. Frey B, McQuillan PJ, Shann F, Freezer N (2001) Nasopharyngeal oxygen therapy produces positive end-expiratory pressure in infants. Eur J Pediatr 160:556–560
    • View reference on PubMed
    • View reference on publisher's website
  6. McKiernan C, Chua LC, Visintainer PF, Allen H (2010) High flow nasal cannulae therapy in infants with bronchiolitis. J Pediatr 156:634–638
    • View reference on PubMed
    • View reference on publisher's website
  7. Campbell DM, Shah PS, Shah V, Kelly EN (2006) Nasal continuous positive airway pressure from high flow cannula versus Infant Flow for preterm infants. J Perinatol 26:546–549
    • View reference on PubMed
    • View reference on publisher's website
  8. Shoemaker MT, Pierce MR, Yoder BA, DiGeronimo RJ (2007) High flow nasal cannula versus nasal CPAP for neonatal respiratory disease: a retrospective study. J Perinatol 27:85–91
    • View reference on PubMed
    • View reference on publisher's website
  9. Dysart K, Miller TL, Wolfson MR, Shaffer TH (2009) Research in high flow therapy: mechanisms of action. Respir Med 103:1400–1405
    • View reference on PubMed
    • View reference on publisher's website
  10. Spence KL, Murphy D, Kilian C, McGonigle R, Kilani RA (2007) High-flow nasal cannula as a device to provide continuous positive airway pressure in infants. J Perinatol 27:772–775
    • View reference on PubMed
    • View reference on publisher's website
  11. Wilkinson DJ, Andersen CC, Smith K, Holberton J (2008) Pharyngeal pressure with high-flow nasal cannulae in premature infants. J Perinatol 28:42–47
    • View reference on PubMed
    • View reference on publisher's website
  12. Spentzas T, Minarik M, Patters AB, Vinson B, Stidham G (2009) Children with respiratory distress treated with high-flow nasal cannula. J Intensive Care Med 24:323–328
    • View reference on PubMed
    • View reference on publisher's website
  13. Kubicka ZJ, Limauro J, Darnall RA (2008) Heated, humidified high-flow nasal cannula therapy: yet another way to deliver continuous positive airway pressure? Pediatrics 121:82–88
    • View reference on PubMed
    • View reference on publisher's website
  14. Slater A, Shann F, McEniery J (2003) The ANZPIC registry diagnostic codes: a system for coding reasons for admitting children to intensive care. Intensive Care Med 29:271–277
    • View reference on PubMed
  15. Slater A, Shann F (2004) The suitability of the pediatric index of mortality (PIM), PIM2, the pediatric risk of mortality (PRISM), and PRISM III for monitoring the quality of pediatric intensive care in Australia and New Zealand. Pediatr Crit Care Med 5:447–454
    • View reference on PubMed
    • View reference on publisher's website
  16. Alexander J, Tregea S, Slater A (2008) Report of the Australian and New Zealand Paediatric Intensive Care Registry. Australian and New Zealand Intensive Care Society, Carlton South, Victoria

Sign In

Connect with ICM

Top 5 Articles Editors Picks Supplement