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Introduction
Acute hypoxaemic respiratory failure (AHRF) in children is the most frequent reason for non-elective hospital admission. During the initial phase, AHRF is a clinical syndrome defined for the purpose of this study by an oxygen requirement and caused by pneumonia, lower respiratory tract infections, asthma or bronchiolitis. Up to 20% of...
Context in source publication
Context 1
... syndrome of AHRF represents an array of clinical diagnoses such as pneumonia, pneumonitis, acute lower respiratory tract infection, reactive airways (asthma) including small numbers with bronchiolitis older than 12 months of age. For the purpose of this study there will be two groups of patients investigated with a pragmatic and point of care definition, which includes clinically diagnosed: (a) wheeze (obstructive) and reactive airway disease with an oxygen requirement and (b) absent wheeze (non-obstructive) and parenchymal lung disease with an oxygen requirement during hospital admission (table 1). ...Citations
... For older patients different weight banded flow rates were proposed. In two big Randomized Controlled Trials (RCT) for HFNC treatment for older children 1-4 and 0-16 years old, for all causes of respiratory failure, flow rates are proposed according to patient weight as 2 L/kg/min for BW up to 12 kg and a maximum to 25 L/min, 30 L/kg/min for 13-15 kg, 35 L/kg/min for 16-30 kg, 40 L/kg/min for 31-50 kg, and 50 L/kg/min for >50 kg [24,25]. Higher flow rates of 3 L/kg/min that were investigated in the Tramontane 2 study didn't reduce the risk of failure but increased the level of discomfort [26]. ...
... HFNC patients should be monitored at least hourly at the beginning of therapy, as at 1 h, in the majority of the cases, the improvements in vital signs which are the first indexes of success are evolved, according to section 3 (3.1 to 3.6). Different escalation time definitions were recorded in the literature, starting from a mean of 6.7 h to 24 ...
High Flow Nasal Cannula (HFNC) delivers high flowrates of a heated air/oxygen fresh gas breathing mixture, in an open system, at the exact amount of fraction inspired oxygen, and at the optimum hydration level. By definition, due to high flow rates, higher than 2 L/min, it produces a wash out of the anatomic dead space and the End
Importance:
Nasal high-flow oxygen therapy in infants with bronchiolitis and hypoxia has been shown to reduce the requirement to escalate care. The efficacy of high-flow oxygen therapy in children aged 1 to 4 years with acute hypoxemic respiratory failure without bronchiolitis is unknown.
Objective:
To determine the effect of early high-flow oxygen therapy vs standard oxygen therapy in children with acute hypoxemic respiratory failure.
Design, setting, and participants:
A multicenter, randomized clinical trial was conducted at 14 metropolitan and tertiary hospitals in Australia and New Zealand, including 1567 children aged 1 to 4 years (randomized between December 18, 2017, and March 18, 2020) requiring hospital admission for acute hypoxemic respiratory failure. The last participant follow-up was completed on March 22, 2020.
Interventions:
Enrolled children were randomly allocated 1:1 to high-flow oxygen therapy (n = 753) or standard oxygen therapy (n = 764). The type of oxygen therapy could not be masked, but the investigators remained blinded until the outcome data were locked.
Main outcomes and measures:
The primary outcome was length of hospital stay with the hypothesis that high-flow oxygen therapy reduces length of stay. There were 9 secondary outcomes, including length of oxygen therapy and admission to the intensive care unit. Children were analyzed according to their randomization group.
Results:
Of the 1567 children who were randomized, 1517 (97%) were included in the primary analysis (median age, 1.9 years [IQR, 1.4-3.0 years]; 732 [46.7%] were female) and all children completed the trial. The length of hospital stay was significantly longer in the high-flow oxygen group with a median of 1.77 days (IQR, 1.03-2.80 days) vs 1.50 days (IQR, 0.85-2.44 days) in the standard oxygen group (adjusted hazard ratio, 0.83 [95% CI, 0.75-0.92]; P < .001). Of the 9 prespecified secondary outcomes, 4 showed no significant difference. The median length of oxygen therapy was 1.07 days (IQR, 0.50-2.06 days) in the high-flow oxygen group vs 0.75 days (IQR, 0.35-1.61 days) in the standard oxygen therapy group (adjusted hazard ratio, 0.78 [95% CI, 0.70-0.86]). In the high-flow oxygen group, there were 94 admissions (12.5%) to the intensive care unit compared with 53 admissions (6.9%) in the standard oxygen group (adjusted odds ratio, 1.93 [95% CI, 1.35-2.75]). There was only 1 death and it occurred in the high-flow oxygen group.
Conclusions and relevance:
Nasal high-flow oxygen used as the initial primary therapy in children aged 1 to 4 years with acute hypoxemic respiratory failure did not significantly reduce the length of hospital stay compared with standard oxygen therapy.
Trial registration:
anzctr.org.au Identifier: ACTRN12618000210279.
Objective:
To investigate the effect of comprehensive nursing intervention in the management of pediatric patients with respiratory failure.
Methods:
A total of 60 pediatric patients were selected as research subjects, and the clinical data were collected and retrospectively investigated. The patients were divided either into a control group (n=30) or an observation group (n=30) according to the nursing care methods. Pediatric patients from the observation group underwent comprehensive nursing intervention, while those in the control group received conventional nursing care intervention. The clinical effects, negative emotions, SF-36 scores, hospital stays, clinical symptom indicators, blood gas indices, lung function indicators and the nursing satisfaction rates were compared between the two groups.
Results:
The clinical effect in the observation group was significantly better than that in the control group. Compared with those in the control group, significantly lower scores of the Self-Rating Anxiety Scale and the Self-Rating Depression Scale were observed in the observation group. The indicators associated with blood gas and lung function in the observation group were significantly improved in contrast to those in the control group. Moreover, the disappearance time of pulmonary rales, disappearance time of cyanochroia, alleviation time of dyspnea and hospital stays in the observation group were significantly shorter than those in the control group, while the SF-36 scores and the nursing satisfaction rate in the observation group were significantly higher than those in the control group (all P<0.05).
Conclusion:
Comprehensive nursing intervention significantly improved clinical treatment effects and patient satisfaction, alleviated the clinical symptoms, increased life quality and shortened hospital stay. So, it is worth being promoted in clinical practice.
The aim of this study si to revise the use of non-invasive ventilation (NIV) in patients with acute respiratory failure in emergency departments. A systematized database review will be carried out by the search of articles attending the presented subject following a unique approach; restricting the results to findings in the last five years either in Spanish or English. A research performed in paediatric population concluded that the early management of acute respiratory failure and the use of high flow nasal cannulae reduced the hospitalization period and the referral to specialized hospitals, and gave more independence to regional hospitals in its management; reducing, therefore, the number of patients needing the implementation of invasive procedures. With respect to patients with exacerbations of the chronic obstructive pulmonary disease (COPD) and its early management in the prehospital care, an increase in the mortality in those patients who were exposed to high flow compared to the conventional oxygen therapy was observed. Following the results of a meta-analysis, no benefits were found in the use of high flow nasal cannulae opposed to the conventional therapy or NIV in the emergency departments, in terms of need for intubations, failures in the treatment, hospitalization and mortality.The data are inconclusive in all the studies analyzed and there is no agreement between the different authors. There is a scarce piece of bibliography regarding the use of NIV in the emergency departments due to the fact that the majority of the research are focused on the use of this techniques in intensive care units. In conclussion, there is a diversity in the results of the revised articles according to the use of NIV in the emergency departments.
The aim: To study the clinical manifestations, capillary blood saturation, frequency of respiratory failure in patients with complicated forms of acute respiratory viral infections (ARVI). Materials and methods: The study included 70 patients with ARVI (mean age was 46.5±9.2 years). Patients observed were randomized into 2 groups. In group 1 (n=30), the only basic therapy was prescribed. In group 2 in addition to the basic therapy the inhalations with high concentrated oxygen with Camomile Oil were used. Results: It is proved that the use of highly concentrated oxygen with camomile oil in the inhalation treatment regimen significantly reduces the duration of local respiratory symptoms (p<0.001) and symptoms of general intoxication (p<0.001), prolonged hospital stay decreases by an average of 5 days (p<0.001). The relief of symptoms of RF in group 2 was noted for 10 days of hospitalization with an increase in capillary blood saturation (SatO2,%) to 95.2±2.91. Absolute therapeutic efficacy (absolute efficacy) of the correction of RF during complex treatment with the addition of highly concentrated oxygen was 88.0% versus 57.0% in group 1. Relative efficacy (RE) – 0.65 [0.46-0.90], odds ratio (OR) – 0.19 [0.06-0.61], p<0.05. The positive effect of highly concentrated oxygen for local immunity state – the level of secretory immunoglobulin A (p<0.001) and lysozyme (p<0.001) was established. Conclusions: High-concentrated oxygen inhalations adding camomile oil is effective in complex treatment at patients with complicated forms of acute respiratory viral infections.
Introduction:
Oxygen therapy through a high-flow nasal cannula is thought to improve the work of breathing and the comfort of patients with acute bronchiolitis. It is widely used in hospital wards and critical care of pediatric patients. However, there is uncertainty on the magnitude of the effect on critical and important outcomes in these patients.
Objectives:
The objective of this review is to evaluate the available evidence on the use of oxygen administered through high-flow cannula versus low-flow oxygen for the treatment of acute bronchiolitis in children under two years of age.
Methodology:
We carried out a systematic review and a meta-analysis following the PRISMA standards for reporting. The search was carried out in electronic databases by two researchers independently. The evidence was summarized using the GRADE methodology.
Results:
Six randomized and non-randomized clinical trials were included, including 1867 individuals younger than 24 months of age with acute bronchiolitis in pediatric emergency, hospitalization, and intensive care services. Mortality was not reported in the included studies. Treatment failure occurred in 108/933 in the high flow group and 233/934 in the low flow group (relative risk: 0.46; 95% confidence interval: 0.35 to 0.62), which shows 11.7% less treatment failure (95% confidence interval between 7.9% and 14.5% less) in the high flow group with a number needed to treat of 7.5 (95% confidence interval 6 to 10) with moderate certainty in the evidence.
Conclusion:
The use of humidified and heated oxygen with high flow compared to oxygen at low flow is probably associated with decreased treatment failure in children younger than two years with acute bronchiolitis. There is uncertainty about the effect on hospitalization days and clinical progression.
