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Research ArticleOriginal Research

Modalities and Complications Associated With the Use of High-Flow Nasal Cannula: Experience in a Pediatric ICU

Florent Baudin, Sebastien Gagnon, Benjamin Crulli, François Proulx, Philippe Jouvet and Guillaume Emeriaud
Respiratory Care October 2016, 61 (10) 1305-1310; DOI: https://doi.org/10.4187/respcare.04452
Florent Baudin
Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada.
Pediatric Intensive Care Unit, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Bron, France.
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Sebastien Gagnon
Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada.
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Benjamin Crulli
Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada.
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François Proulx
Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada.
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Philippe Jouvet
Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada.
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Guillaume Emeriaud
Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada.
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  • For correspondence: [email protected]
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Abstract

BACKGROUND: High-flow nasal cannula (HFNC) therapy is increasingly used in pediatric ICUs as an intermediate level of support between conventional oxygen delivery and noninvasive ventilation (NIV). The safety of HFNC has seldom been studied, and some cases of barotrauma have been reported. This retrospective study aims to describe HFNC use in a tertiary care pediatric ICU, with a focus on the complications associated with this therapy.

METHODS: Between January 2013 and January 2014, all children <18 y old treated with HFNC in the pediatric ICU were included. Demographic data, HFNC settings, chest radiograph reports, and blood gas values were gathered from the electronic medical records. Episodes of pneumothorax, pneumomediastinum, and significant epistaxis were noted. Pneumothorax was distinguished from chest tube-related air leak (frequent after cardiac surgery), which was defined as a small pneumothorax with no clinical impact that resolved spontaneously after chest tube removal.

RESULTS: During the 1-y study period, there were 177 HFNC episodes, involving 145 subjects with a median (interquartile range) age of 8 (2–28) months. HFNC was used as primary support in 31% of episodes, after extubation in 36% and after NIV in 18%. HFNC was administered exclusively for nitric oxide delivery in 16% of episodes. Two children (1%) developed new pneumothoraces that required chest tube insertion, whereas 5 (3%) chest tube-related air leaks were noted. One (0.6%) episode of significant epistaxis was noted. Among 6 preexisting pneumothoraces, none worsened under HFNC. Failure of HFNC occurred in 32 episodes, requiring transition to NIV in 28 cases and endotracheal intubation in 5 cases.

CONCLUSIONS: Support with HFNC following a clinical protocol in pediatric ICUs was associated with a relatively low rate of complications. Since HFNC use is increasing, further evidence is needed to confirm its efficacy and safety.

  • high-flow nasal cannula
  • children
  • barotrauma
  • pediatric ICU
  • pneumothorax
  • noninvasive ventilation
  • complications

Footnotes

  • Correspondence: Guillaume Emeriaud MD PhD, Department of Pediatrics, CHU Sainte Justine, 3175 Chemin Côte Sainte Catherine, Montreal, Quebec H3T 1C5, Canada. E-mail: guillaume.emeriaud{at}umontreal.ca.
  • Supplementary material related to this paper is available at http://www.rcjournal.com.

  • Mr Gagnon was supported by the COPSE program of the Université de Montréal. Dr Emeriaud holds a Clinical Research Scholarship from the Fonds de la Recherche en Santé du Québec. The authors have disclosed no conflicts of interest.

  • Dr Baudin presented a version of this paper at the 43rd International Congress on Intensive Care Medicine of the Société de Réanimation de Langue Française (SRLF), held January 21–23, 2015, in Paris, France.

  • Copyright © 2016 by Daedalus Enterprises
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Respiratory Care: 61 (10)
Respiratory Care
Vol. 61, Issue 10
1 Oct 2016
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Modalities and Complications Associated With the Use of High-Flow Nasal Cannula: Experience in a Pediatric ICU
Florent Baudin, Sebastien Gagnon, Benjamin Crulli, François Proulx, Philippe Jouvet, Guillaume Emeriaud
Respiratory Care Oct 2016, 61 (10) 1305-1310; DOI: 10.4187/respcare.04452

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Modalities and Complications Associated With the Use of High-Flow Nasal Cannula: Experience in a Pediatric ICU
Florent Baudin, Sebastien Gagnon, Benjamin Crulli, François Proulx, Philippe Jouvet, Guillaume Emeriaud
Respiratory Care Oct 2016, 61 (10) 1305-1310; DOI: 10.4187/respcare.04452
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Keywords

  • high-flow nasal cannula
  • children
  • barotrauma
  • pediatric ICU
  • pneumothorax
  • noninvasive ventilation
  • complications

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