loading page

Predictive features of HFNC failure in infants with acute bronchiolitis and high-flow nasal cannula
  • +7
  • Enrica Mancino,
  • Raffaella Nenna,
  • Domenico Paolo La Regina,
  • Luca Cristiani,
  • Greta Di Mattia,
  • Daniela Pepino,
  • Antonella Frassanito,
  • Laura Petrarca,
  • Luigi Matera,
  • Fabio Midulla
Enrica Mancino
University of Rome
Author Profile
Raffaella Nenna
"Sapienza" University of Rome
Author Profile
Domenico Paolo La Regina
University of Rome
Author Profile
Luca Cristiani
Sapienza University of Rome
Author Profile
Greta Di Mattia
University of Rome
Author Profile
Daniela Pepino
University of Rome
Author Profile
Antonella Frassanito
Policlinico Umberto I
Author Profile
Laura Petrarca
"Sapienza" University of Rome
Author Profile
Luigi Matera
University of Rome
Author Profile
Fabio Midulla
University of Rome
Author Profile

Abstract

Introduction Acute bronchiolitis is the most common respiratory illness and the main cause of respiratory failure in infant. Effective therapy is not available. A relatively new, safe and promising method of non-invasive respiratory support is oxygen delivery by high-flow nasal cannula (HFNC), but several questions concerning HFNC clinical practice remain unanswered. Aim The main aim of our study is to analyse the clinical course of infants hospitalized for bronchiolitis who underwent HFNC in order to identify clinical, laboratory or radiological findings that can have an impact on HFNC failure, which is defined as requirement for mechanical ventilation (MV). Methods We conducted a retrospective data analysis of case records of 130 patients less than 12 months hospitalized for bronchiolitis who underwent HFNC and clinical epidemiological laboratory and radiological data were collected. Results Only 11 (8.5%) out 130 infants required invasive mechanical ventilation for clinical deterioration. Patients who needed to switch from HFNC to MV because of a progressive respiratory failure showed more frequently a complete upper lobe consolidation on CXR (90.9%) than infants exclusively supported by HFNC (14.9%). They were younger with a lower admission weight and they had a lower lymphocyte count than patients who underwent HFNC only. Discussion Our study suggests that a complete upper lobe consolidation in young infants is a significant risk factor for HFNC failure. Further studies are needed to understand if an early identification of consolidation following by an adequate follow-up and proper therapeutic strategies may reduce the number of children who require mechanical ventilation.

Peer review status:UNDER REVIEW

29 Jul 2020Submitted to Pediatric Pulmonology
29 Jul 2020Assigned to Editor
29 Jul 2020Submission Checks Completed
30 Jul 2020Reviewer(s) Assigned
14 Aug 2020Review(s) Completed, Editorial Evaluation Pending