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Is treatment with a high flow nasal cannula effective in acute viral bronchiolitis? A physiologic study

  • Pediatric Original
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An Erratum to this article was published on 06 April 2013

Abstract

Purpose

The high flow nasal cannula (HFNC) has recently been proposed to support infants with respiratory syncytial virus (RSV)-related respiratory distress. However, in this disease, no physiologic data are currently available on the effects of this device. We assessed the capacity of HFNC to generate positive airway pressure, as well as the resulting effects on breathing pattern and respiratory effort.

Methods

Twenty-one infants less than 6 months old with acute RSV bronchiolitis were studied prospectively in the pediatric intensive care unit of a university hospital. Pharyngeal pressure (PP) and esophageal pressure (Pes) were measured simultaneously at four increasing flows of 1, 4, 6 and 7 L/min delivered through HFNC.

Results

The PP was correlated with flow rate (r = 0.65, p ≤ 0.0001), reaching mean and end-expiratory values of, respectively, 4 (95% CI 3–5) cmH2O and 6.5 (95% CI 5–8) cmH2O at 7 L/min. A flow ≥2 L/kg/min was associated with the generation of a mean pharyngeal pressure ≥4 cmH2O with a sensitivity of 67 %, a specificity of 96 %, a positive predictive value of 75 %, and a negative predictive value of 94.5%. Only flows ≥6 L/min provided positive PP throughout the respiratory cycle. From baseline to maximal flow rate, breathing frequency (p < 0.01), T i/T tot (p < 0.05), Pes swing (p < 0.05) and PTPesinsp/min (p < 0.01), an index of respiratory effort, were reduced.

Conclusions

HFNC with a flow rate equal to or above 2 L/kg/min generated a clinically relevant PP, with improved breathing pattern and rapid unloading of respiratory muscles, in young infants with acute RSV bronchiolitis.

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Authors and Affiliations

  1. Pediatric Intensive Care Unit, University of Montpellier I, 34000, Montpellier, France

    Christophe Milési, Julien Baleine, Sabine Durand, Clémentine Combes, Aline Rideau Batista Novais & Gilles Combonie

  2. Physiological Department, University of Montpellier I, 34000, Montpellier, France

    Stefan Matecki

  3. INSERM ERI 25, Muscle and Pathologies, University of Montpellier I, 34000, Montpellier, France

    Stefan Matecki

  4. Unité de Réanimation Pédiatrique, CHU de Montpellier, Hôpital Arnaud de Villeneuve, 371 Avenue Du Doyen G. Giraud, 34295, Montpellier Cedex 5, France

    Christophe Milési

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  1. Christophe Milési
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  2. Julien Baleine
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  3. Stefan Matecki
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  4. Sabine Durand
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  5. Clémentine Combes
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  6. Aline Rideau Batista Novais
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  7. Gilles Combonie
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Correspondence to Christophe Milési.

Additional information

This work was carried out in the Pediatric Intensive Care Unit, Hôpital Arnaud de Villeneuve, CHU Montpellier, F-34000 France.

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Milési, C., Baleine, J., Matecki, S. et al. Is treatment with a high flow nasal cannula effective in acute viral bronchiolitis? A physiologic study. Intensive Care Med 39, 1088–1094 (2013). https://doi.org/10.1007/s00134-013-2879-y

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  • DOI: https://doi.org/10.1007/s00134-013-2879-y

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