The Science Journal of the American Association for Respiratory Care

2006 OPEN FORUM Abstracts

HIGH FLOW NASAL CANNULA USE IN THE NEONATAL AND CARDIAC INTENSIVE CARE UNITS

Susan A. Roark RRT-NPS, Esther Taylor RRT, Brian Courtois RRT, Beth Mogensen RRT-NPS,             Walter Reeder RRT, Joey Rowe RRT, Katherine Yearwood RRT Children's Healthcare of Atlanta, Atlanta Ga.

Background: High flow nasal cannula, (HFNC) use has increased in the neonatal and pediatric population with the introduction of the Vapotherm 200i, (Vapotherm, Stevenville MD, USA). Vapotherm is a safe and efficient way to deliver high flow and can potentially reduce ventilator days as well as the need for reintubation.

Method:
We reviewed 106 charts, 31 in the NICU, (neonatal intensive care unit) and 75 in the CICU, (cardiothoracic intensive unit) for the following data: diagnosis including reason for intubation; weight; nasal cannula flow rate and FiO2; need for reintubation; number of ventilator days prior to extubation; complications and pt. (patient) tolerance; gestational age.

Results:
Diagnoses varied from preterm infants requiring surgical intervention to term and pediatric pts. with congenital heart disease, cardiomyopathy, and PPHN  (primary pulmonary hypertension). The most common diagnoses in the neonatal group were: prematurity with necrotizing enterocolitis/sepsis, gastroesophageal reflux, and PPHN. In the cardiac group the most common postoperative diagnoses were: Tetrology of Fallot repair, repaired TGA, (Transposition of the Great Vessels), and hypoplastic left heart syndrome status post Sano procedure. Weight ranged from 0.8 kg to 89 kg, with 62% of the pts. weighing < 4 kg. The average flow rate utilized in the NICU population was 4.5 LPM, with FiO2 averaging 37%. In the cardiac group the average flow rate was    higher at 10.7 LPM and the FiO2 averaged 45%. We documented no barotrauma/ volutrauma or skin breakdown. One pt. in the CICU group developed a pneumothorax associated with chest tube removal. Tolerance was demonstrated by the need for sedation and the documented pain score. The average pain score in the group was < 3 and 27% of the total group required no sedation while on HFNC with 40% of the remaining pts. demonstrating the ability to wean. Weaning of sedation was defined as a reduction in the dose and/or frequency within the first 24hrs on HFNC and a continuation of weaning over the next 24hrs with no subsequent increase in dose or frequency. In the CICU group the reintubation rate was decreased by 27% in pts. < 15 days of age weighing 3.1 kg ± 0.7 kg.

Conclusion:
This retrospective study demonstrates the efficacy and safety of the Vapotherm HFNC system in the neonatal and pediatric cardiac population as utilized at Children's Healthcare of Atlanta. We document a high tolerance to this therapy as evidenced with the reduction in sedation requirements in this pt. population. This study demonstrates a reduced need for reintubation in the CICU population and we hope that with further evaluation of our data we will also be able to demonstrate a reduction in ventilator days in both pt. groups as well as a reduced need for reintubation in the NICU population.


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