Efficacy and Safety of High-Flow Nasal Cannula Oxygen Therapy in Moderate and Severe Bronchiolitis SC11-SC14
Dr. Jitendra S Oswal,
Professor and Deputy, Medical Director, Department of Pediatrics, Bharati Vidyapeeth University Medical College and Hospital, Pune, Maharashtra, India.
Introduction: Heated humidified High-Flow Nasal Cannula therapy (HFNC) is a non-invasive form of oxygen delivery, in which oxygen supports respiration by reducing nasopharyngeal dead space, decreasing airway oedema, enhancing ciliary activity and providing positive airway pressure.
Aim: To evaluate efficacy and safety of HFNC oxygen therapy in children with moderate and severe bronchiolitis.
Materials and Methods: The present prospective study was carried out in PICU of a tertiary care hospital over a period of 24 months. Twenty two children between the ages of 2 months to 2 years who were previously healthy and diagnosed with moderate and severe bronchiolitis were included. A standard protocol was used for all the children with regards to the initiation, monitoring and weaning from HFNC. Outcome parameters measured were Heart Rate (HR), Respiratory Rate (RR), oxygen saturation (SpO2), Arterial Blood Gases (ABG), hours of therapy, and failure of HFNC oxygen therapy. Parameters were compared using two tailed test.
Results: Out of 22 children, 15 were male and 7 were female with M:F ratio 2:1. Eight children had moderate bronchiolitis and 14 children had severe bronchiolitis. The mean age (±SD) was 7.18±4.48 months. The mean baseline HR, RR, SpO2, PaCO2, PaO2 levels were 158.50±35.19 beats/min, 68.64±10.72/min, 88.68±2.12%, 31.23±6.12 mmHg, 122.73±44.94 mmHg respectively. At the end of one hour of HFNC oxygen therapy, mean HR was 151.59±14.61 beats/min, RR 59.32±9.61/min, SpO2 99.59±0.59%, PaCO2 30.99±6.16 mmHg and PaO2 125.71±37.12 mmHg. There was statistically significant improvement (p<0.05) in the work of breathing as indicated by fall in mean HR and RR along with increase in mean SpO2 level after one hour of HFNC oxygen therapy. This improvement was consistently seen till the end of the study. The mean hours for which HFNC oxygen therapy was required was 43.27±16.31 hours. One child failed HFNC oxygen therapy and required invasive ventilation. There were no serious adverse events.
Conclusion: HFNC oxygen therapy significantly decreases the work of breathing and improves oxygen saturation in moderate and severe bronchiolitis.