![]() There was no difference seen between the two HFNC systems in the study. A rate of 2 L/kg per minute was chosen as a maximum a priori as it was judged the highest level of HFNC patients could tolerate without worsening agitation or air leak. Given the similarity in drop in PRP at 1.5 L/kg per minute and 2 L/kg per minute, the authors suggest this flow rate yields a plateau effect and minimal further improvement would be seen with increasing flow rates. Further examining these younger and lighter patients, the greatest reduction in PRP was in the lightest patients (less than 5 kg). 38), with all significant changes being in patients less than 8 kg ( P less than. When stratifying the subjects by weight, this effect was not statistically significant for patients heavier than 8 kg ( P =. 001) and a slightly smaller but similar reduction in PRP at 1.5 L/kg per minute. Following the trials, patients remained on HFNC as per usual care with twice-daily PRP measurements until weaned off HFNC.Ī dose-dependent relationship existed between flow and change in PRP, with the greatest reduction in PRP at 2 L/kg per minute flow ( P less than. Each patient received HFNC delivered by both systems in sequence with flow rates of 0.5, 1, 1.5, and 2 L/kg per minute to a maximum of 30 L/min. Thirteen patients had bronchiolitis, three had pneumonia, and five had other respiratory illnesses. Prior data suggested a sample size of 20 would be sufficient to identify a clinically significant effect size. Fifty-four patients met inclusion criteria and 21 were enrolled and completed the study. SynopsisĪ single center recruited patients aged 37 weeks corrected gestational age to 3 years who were admitted to the ICU with respiratory distress. SettingĢ4-bed pediatric intensive care unit in a 347-bed urban free-standing children’s hospital. Single-center prospective observational trial. The authors chose systems from Fisher & Paykel and Vapotherm for their testing. 1 An increasing PRP indicates increasing effort of breathing. Placing a manometer in the esophagus allows measurement of the pressure-rate product (PRP), a previously validated measure of effort of breathing computed by multiplying the difference between maximum and minimum esophageal pressures by the respiratory rate. The definition of HFNC, how to set flow, and aerosolized medication delivery are areas in which more research is needed.Īerosol therapy children high-flow nasal cannula pediatrics.Ĭopyright © 2018 by Daedalus Enterprises.Reliably measuring effort of breathing has proved challenging. Aerosols were delivered by 75% of respondents, predominantly via a vibrating mesh nebulizer placed on the dry side of the humidifier. There was no consensus on the definition of HFNC, how to set initial flow, or how to make adjustments. During aerosol therapy, 13% of respondents decreased HFNC flow, while 23% removed patients from HFNC. Aerosol therapy was delivered by 75% of respondents during HFNC, with 77% of these respondents delivering aerosol via vibrating mesh nebulizer. Noninvasive ventilation or CPAP was used by 88% of respondents as the next step for patients who failed HFNC, with 7% opting for intubation and 5% using other interventions. ![]() Initial flow was set per provider orders by 34% of respondents, per respiratory therapist-driven protocol by 28%, per patient weight by 15%, per patient age by 15% 5% of respondents used other methods. HFNC was defined as any heated gas delivered by nasal cannula by 49% of respondents, whereas 21% defined HFNC as heated gas delivered via nasal cannula at flow greater than or equal to the patient's inspiratory demand, and 16% defined HFNC as any gas delivered via nasal cannula above predefined thresholds. There were 63 responses, of which 98% used HFNC. Paper versions of the survey were also distributed at the annual Children Hospitals Association meeting. The goal of this study was to evaluate current HFNC practice by surveying practicing pediatric respiratory therapists.Ī survey instrument was posted on the American Association for Respiratory Care's AARConnect online social media platform in March 2017. In non-neonatal pediatric patients, there are limited data available to guide HFNC use, and clinical practice may vary significantly. ![]() High-flow nasal cannula (HFNC) use has greatly increased in recent years. ![]()
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