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Use of high-flow nasal cannula in infants with viral bronchiolitis outside pediatric intensive care units

European Journal of Pediatrics volume 178, pages 1479–1484 (2019)Cite this article

Abstract

High-flow nasal cannula (HFNC) is frequently used in infants with acute viral bronchiolitis outside pediatric intensive care units (PICU). A structured questionnaire was sent out to pediatricians of all public French hospitals with pediatric emergency and/or general pediatric departments on their use of HFNC outside PICU (department using HFNC, number of available devices, monitoring, criteria for initiating or stopping HFNC, and personal comments on HFNC). Of the 166 eligible hospitals, 135 answered (96 general and 39 university hospitals; 81.3%), for a total of 217 answering pediatricians. Seventy-two hospitals (53.3%) used HFNC in acute bronchiolitis outside PICU, particularly, general hospitals (59.4% vs 38.5%), and mostly in pediatric general departments (75%). Continuous patient monitoring with a cardiorespiratory monitor was usual (n = 58, 80%). Nursing staff was responsible for 2.7 children on HFNC and checked vital signs 8.6 times per day. Criteria for HFNC initiation and withdrawal were not standardized. Pediatricians had a positive opinion of HFNC and were willing to extend its use to other diseases.

Conclusion: Use of HFNC outside PICU in infants with acute bronchiolitis is now usual, but urgently requires guidelines.

What is Known:
• Acute viral bronchiolitis treatment is only supportive
• High-flow nasal cannula (HFNC) is a respiratory support accumulating convincing clinical evidence in bronchiolitis
• This latter treatment is usually proposed in pediatric intensive care unit (PICU)
What is New:
• HFNC are increasingly used outside PICU in bronchiolitis, particularly, in general hospitals and in pediatric general departments
• Pediatricians are enthusiastic about this device, but validated criteria for initiation and withdrawal are lacking
• Guidelines for the use of HFNC outside PICU are urgently required

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Fig. 1

Abbreviations

GHC:

General hospital center

UHC:

University hospital center

HFNC:

High-flow nasal cannula

PED:

Pediatric emergency department

PGD:

Pediatric general department

PICU:

Pediatric intensive care unit

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Author information

Affiliations

  1. Service de Médecine Infantile et Pneumologie pédiatrique, CHU Timone-Enfants, 264 rue Saint-Pierre, 13385, Marseille Cedex 5, France

    Mélanie Panciatici, Candice Fabre, Marion Dequin, Nathalie Stremler-Le Bel, Emmanuelle Bosdure & Jean-Christophe Dubus

  2. Service d’Evaluation médicale, Pôle de Santé publique, Hôpital de la Conception, Marseille, France

    Sophie Tardieu

  3. Service de pédiatrie, Hôpital Saint-Joseph, Marseille, France

    Emilie Sauvaget

  4. IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, Aix Marseille Université, Marseille, France

    Jean-Christophe Dubus

Authors
  1. Mélanie Panciatici
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  2. Candice Fabre
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  4. Emilie Sauvaget
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  5. Marion Dequin
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  6. Nathalie Stremler-Le Bel
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  7. Emmanuelle Bosdure
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  8. Jean-Christophe Dubus
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Contributions

MP, CF, ES, and JCD conceived the study and designed the trial. JCD and EB supervised data collection. ST provided statistical advice on study design and analyzed the data. MP and CF drafted the manuscript, and all authors contributed substantially to its revision. JCD takes responsibility for the paper as a whole.

Corresponding author

Correspondence to Mélanie Panciatici.

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Mélanie Panciatici and Candice Fabre are declared as co-first authors

Communicated by Peter de Winter

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Panciatici, M., Fabre, C., Tardieu, S. et al. Use of high-flow nasal cannula in infants with viral bronchiolitis outside pediatric intensive care units. Eur J Pediatr 178, 1479–1484 (2019). https://doi.org/10.1007/s00431-019-03434-4

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  • DOI: https://doi.org/10.1007/s00431-019-03434-4

Keywords

  • Bronchiolitis
  • High-flow nasal cannula
  • Infant
  • Intensive care