title: [Use of high-flow nasal cannula in infants with bronchiolitis in a pediatric emergency department].
abstract: High-flow nasal cannula oxygen therapy (HFNC) is a technique for noninvasive ventilation commonly used in pediatric intensive care units for respiratory distress, particularly in acute bronchiolitis. HFNC was introduced in the pediatric emergency department of the Reims university hospital for the treatment of infants with moderate to severe acute viral bronchiolitis. This retrospective observational study aimed to investigate the use of HFNC in a pediatric emergency ward, describing the groups of infants with acute viral bronchiolitis to be treated either with conventional oxygen therapy or with HFNC therapy. A total of 89 infants aged less than 6 months were included between December 2013 and April 2014. The choice of the type of oxygen used belonged to the pediatrician, according to his or her assessment of the clinical severity of the patient's condition, guided by a protocol of HFNC use for the treatment of moderate to severe bronchiolitis and limited by the availability of a single device in the department. Eighty-nine infants were included; 64% were boys. Fifty-seven infants (64%) had no medical history. At admission, 39 infants (46.4%) had tachypnea and 75 (84.3%) intercostal indrawing. RSV was found in 75 infants (97.4% of infants had a positive respiratory virology test). Seventy-six infants (85.4%) were treated with conventional oxygen therapy and 13 (14.6%) with HFNC. At admission, the mean weight for infants treated with HFNC was lower (P=0.03), the oxygen saturation level was 86.7% versus 93.5% (P=0.03) for conventional oxygen therapy. Moreover, modified Wood's score was higher and the mean PCO2was 61.1 versus 49.9mmHg (P<0.01). Six infants treated with conventional oxygen therapy (7.9%) and six with HFNC (46.1%) were then transferred to an intensive care unit. HFNC therapy in the pediatric emergency ward seems to be an advantageous therapeutic option in the early treatment of infants with moderate to severe bronchiolitis, but further studies are needed to specify its indications and effectiveness.
authors.affiliation: Pédiatrie A, AMH, CHU de Reims, 47, rue Cognacq-Jay, 51092 Reims cedex, France. Electronic address: guimaraes.magali@neuf.fr.
authors.forename: M
authors.initials: M
authors.lastname: Guimaraes
authors.affiliation: Pneumologie pédiatrique, service de réanimation néonatale et infantile, 47, rue Cognacq-Jay, 51092 Reims cedex, France.
authors.forename: M
authors.initials: M
authors.lastname: Pomedio
authors.affiliation: Pneumologie pédiatrique, pathologie du sommeil, AMH, CHU de Reims, 47, rue Cognacq-Jay, 51092 Reims cedex, France.
authors.forename: M
authors.initials: M
authors.lastname: Viprey
authors.affiliation: Unité d'aide méthodologique, pôle recherche et innovations, hôpital Robert-Debré, CHU de Reims, avenue du Général-Koenig, 51092 Reims cedex, France.
authors.forename: L
authors.initials: L
authors.lastname: Kanagaratnam
authors.affiliation: Pneumologie pédiatrique, structure interne pédiatrie A, AMH, CHU de Reims, 47, rue Cognacq-Jay, 51092 Reims cedex, France.
authors.forename: K
authors.initials: K
authors.lastname: Bessaci
mesh_terms: D001990:Bronchiolitis, Viral / Q000628:therapy*; D002245:Carbon Dioxide / Q000097:blood; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D063087:Noninvasive Ventilation; D010100:Oxygen / Q000097:blood; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D012189:Retrospective Studies
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen