Predictive features of HFNC failure in infants with acute bronchiolitis
and high-flow nasal cannula
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.