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American Academy of Pediatrics
Brief Reports

Physiometric Response to High-Flow Nasal Cannula Support in Acute Bronchiolitis

Anthony A. Sochet, Miranda Nunez, Mia Maamari, Scott McKinley, John M. Morrison and Thomas A. Nakagawa
Hospital Pediatrics January 2021, 11 (1) 94-99; DOI: https://doi.org/10.1542/hpeds.2020-001602
Anthony A. Sochet
aDivisions of Pediatric Critical Care Medicine,
bDepartment of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland; and
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Miranda Nunez
aDivisions of Pediatric Critical Care Medicine,
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Mia Maamari
cDivision of Pediatric Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
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Scott McKinley
dPediatric Pulmonology, and
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John M. Morrison
ePediatric Hospital Medicine, Johns Hopkins All Children’s Hospital, St Petersburg, Florida;
fDivision of Hospital Medicine and
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Thomas A. Nakagawa
aDivisions of Pediatric Critical Care Medicine,
bDepartment of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland; and
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Abstract

OBJECTIVES: To describe the rate of high-flow nasal cannula (HFNC) nonresponse and paired physiometric responses (changes [∆] in heart rate [HR] and respiratory rate [RR]) before and after HFNC initiation in hospitalized children with bronchiolitis.

METHODS: We performed a single-center, prospective descriptive study in a PICU within a quaternary referral center, assessing children aged ≤2 years admitted for bronchiolitis on HFNC from November 2017 to March 2020. We excluded for cystic fibrosis, airway anomalies, pulmonary hypertension, tracheostomy, neuromuscular disease, congenital heart disease, or preadmission intubation. Primary outcomes were paired ∆ and %∆ in HR and RR before and after HFNC initiation. Secondary outcomes were HFNC nonresponse rate (ie, intubation or transition to noninvasive positive pressure ventilation). Analyses included χ2, Student’s t, Wilcoxon rank, and paired testing.

RESULTS: Of the 172 children studied, 56 (32.6%) experienced HFNC nonresponse at a median of 14.4 (interquartile range: 4.8–36) hours and 11 (6.4%) were intubated. Nonresponders had a greater frequency of bacterial pneumonia, but otherwise no major differences in demographics, comorbidities, or viral pathogens were noted. Responders experienced reductions in both %ΔRR (−17.1% ± 15.8% vs +5.3% ± 22.3%) and %ΔHR (−6.5% ± 10.5% vs 0% ± 10.9%) compared with nonresponders.

CONCLUSIONS: In this prospective, observational cohort study, we provide baseline data describing expected physiologic changes after initiation of HFNC for children admitted to the PICU for bronchiolitis. In our descriptive analysis, patients with comorbid bacterial pneumonia appear to be at additional risk for subsequent HFNC nonresponse.

  • Copyright © 2021 by the American Academy of Pediatrics
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Hospital Pediatrics: 11 (1)
Hospital Pediatrics
Vol. 11, Issue 1
1 Jan 2021
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Physiometric Response to High-Flow Nasal Cannula Support in Acute Bronchiolitis
Anthony A. Sochet, Miranda Nunez, Mia Maamari, Scott McKinley, John M. Morrison, Thomas A. Nakagawa
Hospital Pediatrics Jan 2021, 11 (1) 94-99; DOI: 10.1542/hpeds.2020-001602

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Physiometric Response to High-Flow Nasal Cannula Support in Acute Bronchiolitis
Anthony A. Sochet, Miranda Nunez, Mia Maamari, Scott McKinley, John M. Morrison, Thomas A. Nakagawa
Hospital Pediatrics Jan 2021, 11 (1) 94-99; DOI: 10.1542/hpeds.2020-001602
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