Doğu Anadolu’da Yeni Kurulan Bir Çocuk Bakım Ünitesinde HFNC Deneyimi

Year 2024, , 860 - 871, 21.10.2024

Muhammed Selçuk Sinanoğlu , Nagehan Aslan , Emrullah Arıkanoğlu , Nizami Avci , Uğur Saraç , Dinçer Yıldızdaş

https://doi.org/10.33715/inonusaglik.1532968

Abstract

Yüksek akışlı nazal kanül oksijen tedavisi (HFNC), akut solunum yetmezliği tedavisinde gün geçtikçe daha sık kullanılmaktadır. Solunum sıkıntısı olan hastalarda önemli etkileri mevcuttur. Çalışmamızda, yeni kurulan çocuk yoğun bakım ünitemizdeki HFNC deneyimlerimizi paylaşmayı planladık. Bu retrospektif çalışmaya 1 ay 18 yaş arası tüm çocuklar dahil edildi. Toplam 126 hastanın 74’ü (%58,7) erkekti. Ortalama yaş 59,8±66,7 ay idi. Hastaların tedavi öncesi, tedavi sonrası 1.saat, 8.saat ve 24.saatteki kalp atım sayıları, oksijen saturasyonları ve solunum sayıları arasında istatistiksel olarak anlamlı farklılık görüldü. Hastaların 16’sı (%12,7) HFNC başarısızlığı sonucu entübe edildi. Entübe edilenlerin başvurudaki SpO2/FiO2 oranı entübe edilmeyenlerin değerinden anlamlı şekilde düşük bulundu (p<0,001). Entübe edilen hastaların başvuru HFNC FiO2 değeri, yoğun bakım yatış süresi ve hastanede yatma süresi entübe edilmeyenlerin değerlerinden anlamlı şekilde yüksek saptandı (p<0,001). Tedavi başarısızlığına ve olası komplikasyonlara dikkat edilerek HFNC’nin çocuk yoğun bakım ünitelerinde çeşitli akut solunum sıkıntısı etiyolojilerinde başarılı bir şekilde kullanılabileceğini düşünüyoruz.

Keywords

Çocuk, Yoğun bakım, Yüksek akışlı nazal kanül oksijen tedavisi

HFNC EXPERIENCE IN A NEWLY ESTABLISHED PEDIATRIC INTENSIVE CARE UNIT IN EASTERN ANATOLIA

Abstract

High-flow nasal cannula oxygen therapy (HFNC) is increasingly used in the treatment of acute respiratory failure. It has important effects in patients with respiratory distress. In our study, we planned to share our HFNC experiences in our newly established pediatric intensive care unit. All children between the ages of 1 month and 18 years were included in this retrospective study. Of the 126 patients, 74 (58.7%) were male. The mean age was 59.8±66.7 months. Significant differences were observed between the heart rate, oxygen saturation and respiratory rate of the patients before treatment and at the 1st, 8th and 24th hours after treatment. 16 (12.7%) of the patients were intubated due to HFNC failure. The SpO2/FiO2 ratio at presentation of those who were intubated was found to be significantly lower than the value of those who were not intubated (p<0.001). The admission HFNC FiO2 value, intensive care unit stay and hospital stay of intubated patients were found to be significantly higher than the values of non-intubated patients (p<0.001). We believe that HFNC can be used successfully in pediatric intensive care units for various etiologies of acute respiratory distress, paying attention to treatment failure and possible complications.

Keywords

High flow nasal cannula oxygen therapy, Intensive care, Pediatric

References

• Akyıldız, B., Öztürk, S., Ülgen-Tekerek, N., Doğanay, S. & Görkem, S. B. (2018). Comparison between high-flow nasal oxygen cannula and conventional oxygen therapy after extubation in pediatric intensive care unit. Turk J Pediatr, 60(2), 126-33.
• Baudin, F,, Gagnon, S., Crulli, B., Proulx, F., Jouvet, P, & Emeriaud, G. (2016). Modalities and Complications Associated With the Use of High-Flow Nasal Cannula: Experience in a Pediatric ICU. Respir Care, 61(10), 1305-10.
• Byerly, F.L., Haithcock, J.A., Buchanan, I.B., Short, K. A. & Cairns, B. A. (2006). Use of high flow nasal cannula on a pediatric burn patient with inhalation injury and post-extubation stridor. Burns, 32(1), 121-5.
• Dafydd, C., Saunders, B.J., Kotecha, S.J. & Edwards, M.O. (2021). Efficacy and safety of high flow nasal oxygen for children with bronchiolitis: systematic review and meta-analysis. BMJ Open Respir Res, 8(1), 000844.
• Er, A., Çağlar, A., Akgül, F., Ulusoy, E., Çitlenbik, H., Yılmaz, D. & Duman, M. (2018). Early predictors of unresponsiveness to high-flow nasal cannula therapy in a pediatric emergency department. Pediatr Pulmonol, 53(6), 809-15.
• Esteban-Zubero, E., García-Muro, C., Alatorre-Jiménez, M. A., Johal, V., López-García, C. A. & Marín-Medina, A. (2022). High Flow Nasal Cannula Therapy in the Emergency Department: Main Benefits in Adults, Pediatric Population and against COVID-19: A Narrative Review. Acta Medica (Hradec Kralove), 65(2), 45-52. Frat, J.P., Thille, A.W., Mercat, A., et al. (2015). High‐flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med, 372(23), 2185‐96.
• Franklin, D., Babl, F. E., Schlapbach, L.J., Oakley, E., Craig, S., Neutze, J., Furyk, J., Fraser, J. F., Jones, M., Whitty, J.A., Dalziel, S. R. & Schibler, A. (2018). A Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitis. N Engl J Med, 378(12), 1121-31.
• Garland, H., Gunz, A. C., Miller, M.R. & Lim RK. (2020). High-flow nasal cannula implementation has not reduced intubation rates for bronchiolitis in Canada. Paediatr Child Health, 26(4), 194-8.
• Gürün Kaya, A., Öz, M., Erol, S., Çiftçi, F., Çiledağ, A. & Kaya, A. (2020). High flow nasal cannula in COVID-19: a literature review. Tuberk Toraks, 68(2), 168-74.
• Habra, B., Janahi, I. A., Dauleh, H., Chandra, P. & Veten, A. (2020). A comparison between high-flow nasal cannula and noninvasive ventilation in the management of infants and young children with acute bronchiolitis in the PICU. Pediatr Pulmonol, 55(2), 455-61.
• Huang, H. W., Sun, X.M., Shi, Z. H., Chen, G. Q., Chen, L., Friedrich, J. O. &Zhou, J. X. (2018). Effect of High-Flow Nasal Cannula Oxygen Therapy Versus Conventional Oxygen Therapy and Noninvasive Ventilation on Reintubation Rate in Adult Patients After Extubation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Intensive Care Med, 33(11), 609-23.
• Kamit Can, F., Anil, A.B., Anil, M., Zengin, N., Durak, F., Alparslan, C. & Goc, Z. (2018). Predictive factors for the outcome of high flow nasal cannula therapy in a pediatric intensive care unit: Is the SpO2/FiO2 ratio useful? J Crit Care, 44, 436-44.
• Kang, B. J., Koh, Y., Lim, C. M., et al. (2015). Failure of high‐flow nasal cannula therapy may delay intubation and increase mortality. Intensive Care Med, 41(4), 623‐32.
• Khemani, R. G., Smith, L., Lopez-Fernandez, Y. M , Kwok, J., Morzov, R., Klein, M. J., Yehya, N., Willson, D., Kneyber, M. C. J., Lillie, J., Fernandez, A., Newth, C. J. L., Jouvet, P. & Thomas, N.J. (2019). Pediatric Acute Respiratory Distress syndrome Incidence and Epidemiology (PARDIE) Investigators; Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. Paediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE): an international, observational study. Lancet Respir Med, 7(2), 115-28.
• Kwon, J. W. (2020). High-flow nasal cannula oxygen therapy in children: a clinical review. Clin Exp Pediatr , 63(1), 3-7. Lee, M. & Jr Nagler, J. (2020). High‐flow nasal cannula therapy beyond the perinatal period. Curr Opin Pediatr, 29(3), 291‐6. Liu, J., Li, D. Y., Liu, Z. Q., Lu, G. Y., Li, X. Q. & Qiao, L N. (2019). High-risk factors for early failure of high-flow nasal cannula oxygen therapy in children. Zhongguo Dang Dai Er Ke Za Zhi, 21(7), 650-5.
• Ma, X.H., An, M. M., Yin, F., Zhang, J., Peng, M. Y., Guan, H. & Gong, P. (2022). Factors associated with failure of high-flow nasal cannula oxygen therapy in patients with severe COVID-19: a retrospective case series. J Int Med Res, 50(5), 3000605221103525.
• Mas, A. & Masip, J. (2014). Noninvasive ventilation in acute respiratory failure. Int J Chron Obstruct Pulmon Dis, 9, 837-52.
• Mellado-Artigas, R., Ferreyro, B.L., Angriman, F., Hernández-Sanz, M., Arruti, E., Torres, A., Villar, J., Brochard, L. & Ferrando, C. (2021). COVID-19 Spanish ICU Network. High-flow nasal oxygen in patients with COVID-19-associated acute respiratory failure. Crit Care, 25(1), 58.
• McKiernan, C., Chua, L. C., Visintainer, P. F. & Allen, H. (2010). High flow nasal cannulae therapy in infants with bronchiolitis. J Pediatr, 156(4), 634-8.
• Mitsuyama, Y., Nakao, S., Shimazaki, J., Ogura, H. & Shimazu, T. (2022). Effectiveness of high-flow nasal cannula for tracheal intubation in the emergency department. BMC Emerg Med, 22(1), 115.
• Nolasco, S., Manti, S., Leonardi, S., Vancheri, C. & Spicuzza, L.(2022). High-flow nasal cannula oxygen therapy: Physiological mechanisms and clinical applications in children. Front Med (Lausanne), 9, 920549.
• Ospina-Tascón, G.A., Calderón-Tapia, L.E., García, A.F., Zarama, V., Gómez-Álvarez, F., Álvarez-Saa, T., Pardo-Otálvaro, S., Bautista-Rincón, D.F., Vargas, M.P., Aldana-Díaz, J.L., Marulanda, Á., Gutiérrez, A., Varón, J., Gómez, M., Ochoa, M.E., Escobar, E., Umaña, M., Díez, J., Tobón, G.J., Albornoz, L.L., Celemín Flórez, C. A., Ruiz, G. O., Cáceres, E. L., Reyes, L.F., Damiani, L.P. & Cavalcanti, A. B. (2021). HiFLo-Covid Investigators. Effect of High-Flow Oxygen Therapy vs Conventional Oxygen Therapy on Invasive Mechanical Ventilation and Clinical Recovery in Patients With Severe COVID-19: A Randomized Clinical Trial. JAMA, 326(21), 2161-71.
• Peterson, R. J., Hassumani, D. O., Hole, A. J., Slaven, J. E., Tori, A. J. & Abu-Sultaneh, S. (2021). Implementation of a High-Flow Nasal Cannula Management Protocol in the Pediatric ICU. Respir Care, 66(4), 591-9.
• Roca, O., Messika, J., Caralt, B., García-de-Acilu, M., Sztrymf, B., Ricard, J. D. &Masclans, J. R. (2016). Predicting success of high-flow nasal cannula in pneumonia patients with hypoxemic respiratory failure: The utility of the ROX index. J Crit Care, 35, 200-5.
• Schibler, A., Pham, T. M., Dunster, K. R., Foster, K., Barlow, A., Gibbons, K. & Hough, J. L. (2021). Reduced intubation rates for infants after introduction of high-flow nasal prong oxygen delivery. Intensive Care Med, 37(5), 847-52.
• Tongyoo, S., Tantibundit, P., Daorattanachai, K., Viarasilpa, T., Permpikul, C. & Udompanturak, S. (2021). High-flow nasal oxygen cannula vs. noninvasive mechanical ventilation to prevent reintubation in sepsis: a randomized controlled trial. Ann Intensive Care,11(1), 135.
• Wiser, R. K., Smith, A. C., Khallouq, B. B. & Chen, J. G. (2021). A pediatric high-flow nasal cannula protocol standardizes initial flow and expedites weaning. Pediatr Pulmonol, 56(5), 1189-97.
• Yildizdas, D., Yontem, A., Iplik, G., Horoz, O. O. & Ekinci, F. (2021). Predicting nasal high-flow therapy failure by pediatric respiratory rate-oxygenation index and pediatric respiratory rate-oxygenation index variation in children. Eur J Pediatr, 180(4), 1099-106.
• Zhu, Y., Yin, H., Zhang, R., Ye, X. & Wei, J. (2021). High-flow nasal cannula oxygen therapy versus conventional oxygen therapy in patients after planned extubation: a systematic review and meta-analysis. Crit Care, 23(1), 180