Sara Mayfield

High-flow nasal cannula oxygen therapy for infants with bronchiolitis: Pilot study

To obtain data on the safety and clinical impact of managing infants with bronchiolitis on the ward with high‐flow nasal cannula (HFNC) treatment.

The effect of high flow nasal cannula therapy on the work of breathing in infants with bronchiolitis

The main physiological impact of high flow nasal cannula (HFNC) therapy is presumed to be a decrease in work of breathing (WOB). To assess this, diaphragmatic electrical activity and esophageal pressure changes were measured off then on HFNC delivered at 2 L/kg/min, in 14 infants with bronchiolitis and 14 cardiac infants. Electrical activity of the diaphragm (Edi) was measured using an Edi catheter with calculations of signal peak (EdiMAX) and amplitude (EdiAMPL). Pressure–rate and pressure–time products (PRP, PTP) were calculated from analyses of esophageal pressure. Changes in end‐expiratory lung volume were measured using respiratory inductance plethysmography (RIPEEL). The EdiMAX and EdiAMPL were significantly higher in infants with bronchiolitis than in cardiac infants (P < 0.05). Within the bronchiolitis group, both were significantly reduced between HFNC states from 27.9 µV [20.4, 35.4] to 21.0 µV [14.8, 27.2] and from 25.1 µV [18.0, 32.2] to 19.2 µV [13.3, 25.1], respectively (mean, 95% CI, P < 0.05). A less prominent offload of the diaphragm was observed in cardiac infants (P < 0.05). WOB decreased in both groups with a significant reduction of PRP and PTP (P < 0.05). RIPEEL increased significantly in bronchiolitis only (P < 0.05). HFNC offloads the diaphragm and reduces the WOB in bronchiolitis. A similar effect was demonstrated in cardiac infants, a group without signs of airway‐obstruction. Pediatr Pulmonol. 2015; 50:713–720.

A case series of paediatric high flow nasal cannula therapy

INTRODUCTION High flow nasal cannula is an emerging treatment option in Paediatric Intensive Care Units for paediatric patients in acute respiratory distress. Yet there is a paucity of literature describing its clinical application in various presenting pathophysiologies. AIM To describe three cases with differing underlying pathophysiologies and their response to high flow nasal cannula oxygen therapy. METHOD Patients admitted to the Paediatric Intensive Care Unit with bronchiolitis, asthma and cardiomyopathy, and treated with high flow nasal cannula therapy were searched in the Paediatric Intensive Care database. The most representative cases were chosen to review. RESULTS One infant and two children were reviewed. All were commenced on high flow nasal cannula therapy in the Paediatric Intensive Care Unit and all demonstrated an improvement in their work of breathing. There was also a substantial improvement in their haemodynamic status. No patient required escalation to other forms of respiratory therapy. CONCLUSION High flow nasal cannula therapy is a viable treatment option for a range of patients presenting to the Paediatric Intensive Care Unit with acute respiratory distress. More invasive methods of respiratory support may be avoided by the use of high flow nasal cannula therapy.

Procalcitonin in the Early Course Post Pediatric Cardiac Surgery

Objective: Procalcitonin has emerged as a promising infection marker, but previous reports from small-sized studies suggest nonspecific elevation of procalcitonin after pediatric heart surgery. As procalcitonin is increasingly used as a marker for infection in the PICU, the aim of this study was to identify factors associated with postoperative procalcitonin elevation and to investigate the role of procalcitonin as an early marker of outcome after cardiac surgery. Design: Prospective observational study. Setting: Single, tertiary referral PICU. Patients: Patients aged 0–16 years following cardiac surgery with or without cardiopulmonary bypass. Interventions: Procalcitonin was measured in all patients at admission to PICU, and on postoperative day 1 and 2. Outcome variables included major adverse event, length of stay in PICU, postoperative renal failure requiring temporary dialysis, duration of mechanical ventilation and duration of inotropic support. A major adverse event was defined as cardiac arrest, need for postoperative extracorporeal life support or death within 3 months of cardiac surgery. Measurements and Main Results: In 221 included patients who underwent 232 operations, procalcitonin at admission to PICU was significantly associated with mechanical ventilation prior to surgery (p = 0.001), preoperative myocardial dysfunction (p = 0.002), duration of cardiopulmonary bypass (p < 0.001), intraoperative cross-clamp time (p = 0.015), and serum lactate at admission (p < 0.001). Patients suffering a major adverse event and patients with postoperative renal failure had significantly higher procalcitonin levels at admission to PICU (p = 0.04 and 0.01, respectively). Furthermore, procalcitonin levels at admission correlated significantly with the length of stay in the PICU (p = 0.005), time on mechanical ventilation (p = 0.03), and duration of inotropic support (p = 0.02). Conclusions: Elevated levels of procalcitonin in the early phase after pediatric cardiac surgery are a marker for increased risk for major adverse events and postoperative renal failure and increased postoperative morbidity.