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.