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HM14 Special Report: HFNC in Bronchiolitis: Best Thing Since Sliced Bread?

Presenter: Shawn Ralston, MD, Children’s Hospital at Dartmouth and Giesel School of Medicine, Hanover, NH

As the evidence comes in, the use of HFNC in patients with bronchiolitis is likely to be an innovation in pediatric hospital medicine,” said Dr. Ralston, with a potentially large impact on the healthcare of hospitalized children in the U.S.

Key Takeaways

Dr. Ralson provided a succinct overview of the literature surrounding the use of HFNC in patients with bronchiolitis:

  • Over the past 10 years, the incidence rates of bronchiolitis hospitalizations have declined in all age groups, but during the same time period in-hospital use of mechanical ventilation, and therefore hospital charges per case, have increased.
  • Surprisingly, the definition of high-flow nasal cannula (HFNC) is not uniform among institutions. Most would agree that it is a heated circuit of humidified oxygen at flow rates that exceed a patient’s respiratory demand.
  • The goal of the nasal cannula in HFNC is to occupy at least 50% of the nares. If correctly sized, this will provide end-expiratory pressures that reduce the subjective work of breathing in infants.
  • Can we predict the non-responders to HFNC? Failure to decrease respiratory rate (RR) at onset of therapy was associated with intubation, or failure of successful use of HFNC.
  • One needs to be aware of potential biases when evaluating the literature on the use of HFNC in bronchiolitis. Seasonal disease variation, secular trends in ICU and/or ED training, and QI culture in hospital such as guidelines and protocols may all potentially impact study results.

James O’Callaghan is a Clinical Assistant Professor of Pediatrics at the University of Washington and a member of Team Hospitalist.

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