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Les lunettes nasales à haut débit : nouvelle modalité d’oxygénothérapie ou nouvel outil de ventilation non invasive en réanimation pédiatrique ?

High flow nasal canula: Just a new tool for oxygen therapy or a new way to provide non-invasive ventilation in the pediatric intensive care?

  • Paramédical / Healthcare Professionals
  • Published:
Réanimation

Résumé

Les lunettes nasales à haut débit (LNHD) sont un nouveau mode de support respiratoire. En pédiatrie, l’administration d’un gaz humidifié, réchauffé, à un débit supérieur à 2 L/min et ajusté au poids du patient par des lunettes nasales adaptées à la taille des narines permet d’améliorer la délivrance en oxygène, le lavage de l’espace mort et la clairance mucociliaire par rapport aux autres modes d’oxygénation classique. Le dispositif peut potentiellement générer une pression positive pharyngée et modifier sensiblement le travail des muscles respiratoire, le positionnant entre le masque à haute concentration et la pression positive continue. Sa tolérance est généralement excellente et sa mise en oeuvre simple. La littérature pédiatrique suggère un intérêt pour les LNHD dans la prise en charge des bronchiolites de gravité modérée. L’expérience acquise en néonatologie et chez les adultes devrait conduire à évaluer de nouvelles indications, telles que le support respiratoire après extubation et la prise en charge des crises d’asthme modérées. Comme pour tout support ventilatoire, l’initiation des LNHD nécessite une surveillance rigoureuse dans un service de surveillance continue ou de réanimation pédiatrique.

Abstract

High flow nasal cannula (HFNC) is a new mode of respiratory support. In pediatrics, administration through nasal cannula of heated and humidified gas at rates >2 L/min improves oxygen delivery, dead space washing, and mucociliary clearance, compared with conventional oxygenation devices. HNFC generates positive pharyngeal pressure and may improve breathing work. HNFC could thus be considered as a device between high concentration mask and continuous positive airway pressure (CPAP). Tolerance is excellent and implementation simple. HFNC has been suggested as an interesting tool for the management of moderate to severe bronchiolitis. Experience in neonates and adults may encourage considering other indications, like respiratory support following extubation and management of mild asthma.

Like any respiratory support, initiating HFNC requires close monitoring in a pediatrician intensive care unit.

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Références

  1. Spence KL, Murphy D, Kilian C, et al (2007) High-flow nasal cannula as a device to provide continuous positive airway pressure in infants. J Perinatol 27:772–5

    Article  PubMed  CAS  Google Scholar 

  2. Dani C, Pratesi S, Migliori C, Bertini G (2009) High flow nasal cannula therapy as respiratory support in the preterm infant. Pediatr Pulmonol 44:629–34

    Article  PubMed  Google Scholar 

  3. Collins CL, Holberton JR, Barfield C, Davis PG (2013) A randomized controlled trial to compare heated humidified high-flow nasal cannulae with nasal continuous positive airway pressure postextubation in premature infants. J Pediatr 162:949–54

    Article  PubMed  Google Scholar 

  4. Manley BJ, Owen LS, Doyle LW, et al (2013) High-flownasal cannulae in very preterm infants after extubation. N Engl J Med 369:1425–33

    Article  PubMed  CAS  Google Scholar 

  5. Yoder BA, Stoddard RA, Li M, King J, et al (2013) Heated, humidified high-flownasalcannula versus nasal CPAP for respiratory support in neonates. Pediatrics 131:e1482–90

    Article  Google Scholar 

  6. Mayfield S, Jauncey-Cooke J, Hough JL, et al (2014) High-flow nasal cannula therapy for respiratory support in children. Cochrane Database Syst Rev Mar 7;3:CD009850

    Google Scholar 

  7. Roca O, Riera J, Torres F, et al (2010) High-flow oxygen therapy in acute respiratory failure. Respir Care 55:408–13

    PubMed  Google Scholar 

  8. Hasani A, Chapman TH, McCool D, et al (2008) Domiciliary humidification improves lung mucociliary clearance in patients with bronchiectasis. Chron Respir Dis 5:81–6

    Article  PubMed  CAS  Google Scholar 

  9. Rea H, McAuley S, Jayaram L, et al (2010) The clinical utility of long-term humidification therapy in chronic airway disease. Respir Med 104:525–33

    Article  PubMed  Google Scholar 

  10. Fontanari P, Burnet H, Zattara-Hartmann MC, Jammes Y (1996) Changes in airway resistance induced by nasal inhalation of cold dry, dry, or moist air in normal individuals. J Appl Physiol 81:1739–43

    PubMed  CAS  Google Scholar 

  11. Tiep B, Barnett M (2002) High flow nasal vs high flow mask oxygen delivery: tracheal gas concentrations through a head extension airway model. Respir Care 47:1079

    Google Scholar 

  12. Parke RL, McGuinness SP, Eccleston ML (2011) Preliminary Randomized Controlled Trial to Assess Effectiveness of Nasal High-Flow Oxygen in Intensive Care Patients. Respir Care 56:265–70

    Article  PubMed  Google Scholar 

  13. Numa AH, Newth CJ (1996) Anatomic dead space in infants and children. J Appl Physiol 80:1485–9.

    Article  PubMed  CAS  Google Scholar 

  14. Dysart K, Miller T, Wolfson M, et al (2009) Research in high flow therapy: mechanisms of action. Respir Med 103:1400–5

    Article  PubMed  Google Scholar 

  15. Milési C, Baleine J, Matecki S, et al (2013) Is treatment with a high flow nasal cannula effective in acute viral bronchiolitis? A physiologic study. Intensive Care Med. 39:1088–94

    Article  PubMed  Google Scholar 

  16. Spentzas T, Minarik M, Patters AB, et al (2009) Children with respiratory distress treated with high-flow nasal cannula. J Intensive Care Med 24:323–8

    Article  PubMed  Google Scholar 

  17. Wilkinson D, Andersen C, Smith K, Holberton J (2007) Pharyngeal pressure with high-flow nasal cannulae in premature infants. J Perinatol 27:772–5

    Article  Google Scholar 

  18. Teague WG (2003) Noninvasive ventilation in the pediatric intensive care unit for children with acute respiratory failure. Pediatr Pulmonol 35:418–26

    Article  PubMed  Google Scholar 

  19. Rubin S, Ghuman A, Deakers T, et al (2014) Effort of breathing in children receiving high-flow nasal cannula. Pediatr Crit Care Med 15:1–6

    Article  PubMed  Google Scholar 

  20. König K, Stock EL, Jarvis M (2013) Noise levels of neonatal high-flow nasal cannula devices—an in-vitro study. Neonatology 103:264–7

    Article  PubMed  Google Scholar 

  21. Hegde S, Prodhan P (2013) Serious air leak syndrome complicating high-flow nasal cannula therapy: a report of 3 cases. Pediatrics 131:e939–44

    Article  Google Scholar 

  22. Sivieri EM, Gerdes JS, Abbasi S (2013) Effect of HFNC flow rate, cannula size, and nares diameter on generated airway pressures: an in vitro study. Pediatr Pulmonol 48:506–14

    Article  PubMed  Google Scholar 

  23. Carrillo A, Gonzalez-Diaz G, Ferrer M, et al (2012) Non-invasive ventilation in community-acquired pneumonia and severe acute respiratory failure. Intensive Care Med 38:458–66

    Article  PubMed  Google Scholar 

  24. Abboud PA, Roth PJ, Skiles CL, et al (2012) Predictors of failure in infants with viral bronchiolitis treated with high-flow, highhumidity nasal cannula therapy. Pediatr Crit Care Med 13:e343–9

    Article  Google Scholar 

  25. Bressan S, Balzani M, Krauss B, et al (2013) High-flow nasal cannula oxygen for bronchiolitis in a pediatric ward: a pilot study. Eur J Pediatr 172:1649–56

    Article  PubMed  CAS  Google Scholar 

  26. McKiernan C, Chua LC, Visintainer PF, Allen H (2010) High flow nasal cannulae therapy in infants with bronchiolitis. J Pediatr 156:634–8

    Article  PubMed  Google Scholar 

  27. Schibler A, Pham TM, Dunster KR, et al (2011) Reduced intubation rates for infants after introduction of high-flow nasal prong oxygen delivery. Intensive Care Med 37:847–52

    Article  PubMed  CAS  Google Scholar 

  28. Mayfield S, Jauncey-Cooke J, Bogossian F (2013) A case series of paediatric high flow nasal cannula therapy. Aust Crit Care 26:189–92

    Article  PubMed  Google Scholar 

  29. Kelly GS, Simon HK, Sturm JJ (2013) High-flow nasal cannula use in children with respiratory distress in the emergency department: predicting the need for subsequent intubation. Pediatr Emerg Care 29:888–92

    Article  PubMed  Google Scholar 

  30. Chikata Y, Izawa M, Okuda N, et al (2013) Humidification performances of two high flow nasal cannula devices: a bench study. Respir Care [Epub ahead of print]

    Google Scholar 

  31. Campbell EJ, Baker MD, Crites-Silver P (1988) Subjective effects of humidification of oxygen for delivery by nasal cannula. A prospective study. Chest 93:289–93

    CAS  Google Scholar 

  32. Essouri S, Chevret L, Durand P, et al (2006) Noninvasive positive pressure ventilation: five years of experience in a pediatric intensive care unit. Pediatr Crit Care Med 7:329–34

    Article  PubMed  Google Scholar 

  33. ten Brink F, Duke T, Evans J (2013) High-flow nasal prong oxygen therapy or nasopharyngeal continuous positive airway pressure for children with moderate-to-severe respiratory distress? Pediatr Crit Care Med 14:e326–31

    Article  Google Scholar 

  34. Cambonie G, Milési C, Jaber S, et al (2008) Nasal continuous positive airway pressure decreases respiratory muscles overload in young infants with severe acute viral bronchiolitis. Intensive Care Med 34:1865–72

    Article  PubMed  Google Scholar 

  35. Milési C, Matecki S, Jaber S, et al (2013) 6 cmH2O continuous positive airway pressure versus conventional oxygen therapy in severe viral bronchiolitis: a randomized trial. Pediatr Pulmonol 48:45–51

    Article  PubMed  Google Scholar 

  36. Essouri S, Durand P, Chevret L, et al (2011) Optimal level of nasal continuous positive airway pressure in severe viral bronchiolitis. Intensive Care Med. 37:2002–7

    Article  PubMed  Google Scholar 

  37. Metge P, Grimaldi C, Hassid S, et al (2014) Comparison of a high-flow humidified nasal cannula to nasal continuous positive airway pressure in children with acute bronchiolitis: experience in a pediatric intensive care unit. Eur J Pediatr [Epub ahead of print]

    Google Scholar 

  38. Bueno Campaña M, Olivares Ortiz J, Notario Muñoz C, et al (2014) High flow therapy versus hypertonic saline in bronchiolitis: randomised controlled trial. Arch Dis Child [Epub ahead of print]

    Google Scholar 

  39. Rittayamai N, Tscheikuna J, Rujiwit P (2013) High-Flow Nasal Oxygen Cannula versus Conventional Oxygen Therapy After Endotracheal Extubation: A Randomized Cross Over Physiologic Study. Respir Care [Epub ahead of print]

    Google Scholar 

  40. Futier E, Paugam-Burtz C, Constantin JM, et al (2013) The OPERA trial — comparison of early nasal high flow oxygen therapy with standard care for prevention of postoperative hypoxemia after abdominal surgery: study protocol for a multicenter randomized controlled trial. Trials 14:341

    Article  PubMed  PubMed Central  Google Scholar 

  41. Bhashyam AR, Wolf MT, Marcinkowski AL, et al (2008) Aerosol delivery through nasal cannulas: an in vitro study. J Aerosol Med Pulm Drug Deliv 21:181–8

    Article  PubMed  CAS  Google Scholar 

  42. Perry SA, Kesser KC, Geller DE, et al (2013) Influences of cannula size and flow rate on aerosol drug delivery through the Vapotherm humidified high-flow nasal cannula system. Pediatr Crit Care Med 14:e250–6

    Article  Google Scholar 

  43. Ari A, Harwood R, Sheard M, et al (2011) In vitro comparison of heliox and oxygen in aerosol delivery using pediatric high flow nasal cannula. Pediatr Pulmonol 46:795–801

    Article  PubMed  Google Scholar 

  44. Ari A, Atalay OT, Harwood R, et al (2010) Influence of nebulizer type, position, and bias flow on aerosol drug delivery in simulated pediatric and adult lung models during mechanical ventilation. Respir Care 55:845–51

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Réanimation pédiatrique, hôpital Arnaud de Villeneuve, 371 avenue du doyen G. Giraud, F-34295, Montpellier cedex 5, France

    C. Milési, M. Boubal, A. Jacquot, J. Baleine & G. Cambonie

  2. Unidad de cuidados intensivos pediatricos, hospital universitario Sant Joan de Deu, universitat de Barcelona. Esplugues de Llobregat, Barcelona, Spanish

    M. Pons-Odena

Authors
  1. C. Milési
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  2. M. Boubal
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  3. A. Jacquot
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  4. J. Baleine
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  5. M. Pons-Odena
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  6. G. Cambonie
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Correspondence to C. Milési.

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Milési, C., Boubal, M., Jacquot, A. et al. Les lunettes nasales à haut débit : nouvelle modalité d’oxygénothérapie ou nouvel outil de ventilation non invasive en réanimation pédiatrique ?. Réanimation 23, 517–522 (2014). https://doi.org/10.1007/s13546-014-0919-4

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  • DOI: https://doi.org/10.1007/s13546-014-0919-4

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