• Nina M Dadlez, Nora Esteban-Cruciani, Asama Khan, Yi Shi, Kevin J McKenna, Gabriella Azzarone, and William N Southern.
• Division of Pediatric Hospital Medicine, Department of Pediatrics, Floating Hospital For Children at Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts. NDadlez@tuftsmedicalcenter.org.
• Respir Care. 2019 Nov 1; 64 (11): 1410-1415.

BackgroundHigh-flow nasal cannula (HFNC), a form of noninvasive respiratory support, is effective for the treatment of respiratory distress in ICUs. Although HFNC has been used outside of the ICU, there is little research that examines its safety in this less-monitored setting.MethodsChildren ≤ 24 months old admitted with bronchiolitis to a pediatric floor at a tertiary care center from April 1 2013, to March 31 2015, were identified by using standard diagnostic codes. Exclusion criteria were concomitant pneumonia or complex comorbidities. Demographic and clinical characteristics were abstracted. Outcomes included transfer to the ICU, higher levels of respiratory support, intubation, pneumothorax, or aspiration events.ResultsEighty children admitted with bronchiolitis who were treated with HFNC while on the pediatric floor were examined. The median age was 4.6 months, 45% were girls, and the majority were either Hispanic (41%) or black (36%). Flow ranged from 3 to 10 L/min. Thirty-three subjects (41% of the sample) required subsequent transfer to the ICU. No children were intubated or developed a pneumothorax. Eighty-three percent were fed while on HFNC. No children had an aspiration event.ConclusionsHFNC may be a safe modality of respiratory support outside of the ICU for children ages ≤ 24 months with bronchiolitis and without comorbidities up to a maximum flow of 10 L/min. There were no adverse events among the subjects who were fed while on HFNC.Copyright © 2019 by Daedalus Enterprises.

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