Evaluation of prognostic factors for high-flow nasal cannula therapy failure in infants with bronchiolitis: a prospective study.

IF 1.3 4区医学 Q3 PEDIATRICS

Archives De Pediatrie Pub Date : 2025-08-11 DOI:10.1016/j.arcped.2025.06.002

Seyfeddine Zayani, Farah Thabet, Amal Marzouki, Abir Daya, Manel Benfredj, Salma Mhalla, Chokri Chouchane, Slaheddine Chouchane

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引用次数: 0

Abstract

Objective: This study aims to identify factors associated with High-flow nasal cannula (HFNC) therapy failure in infants with moderate to severe bronchiolitis to personalize management and optimize outcomes.

Methods: A prospective cohort study was conducted from September 2021 to March 2023 in a pediatric intensive care unit. Infants aged 0-12 months with bronchiolitis requiring HFNC were included, excluding those with prior ventilation, tracheostomy, uncorrected cyanotic congenital heart disease, or chronic respiratory/neuromuscular conditions. Clinical and biological characteristics were evaluated at HFNC initiation and after 2 hours. Logistic regression was used to identify predictors of failure.

Results: Of 154 patients, 54 (35.1 %) experienced HFNC failure. Univariate analysis showed significant differences in age and weight at admission between responders and non-responders. Multivariate analysis identified weight below the 10th percentile, FiO2 ≥ 42.5 %, and Wang score ≥ 10 at initiation as predictors of failure. Persistence of tachycardia, tachypnea, hypercapnia, and FiO2 ≥ 48.5 % after 2 hours were also significant predictors. Common causes of failure were increased respiratory effort (64.8 %) and severe apnea (18.5 %).

Conclusions: Predictors of HFNC failure include low weight, high initial FiO2, and severe clinical scores, as well as persistent clinical instability during early therapy, aiding clinical decision-making.

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婴儿毛细支气管炎高流量鼻插管治疗失败的预后因素评估：一项前瞻性研究。

目的：本研究旨在确定中重度毛细支气管炎婴儿高流量鼻插管（HFNC）治疗失败的相关因素，以实现个性化治疗和优化结果。方法：一项前瞻性队列研究于2021年9月至2023年3月在儿科重症监护室进行。0-12个月患有毛细支气管炎需要HFNC的婴儿被纳入研究，不包括那些先前有通气、气管切开术、未纠正的紫绀型先天性心脏病或慢性呼吸/神经肌肉疾病的婴儿。在HFNC开始时和2小时后评估临床和生物学特征。使用逻辑回归来确定失败的预测因素。结果：154例患者中，54例（35.1%）发生HFNC衰竭。单因素分析显示，应答者和无应答者入院时的年龄和体重有显著差异。多因素分析确定体重低于第10百分位，FiO2≥42.5%，开始时Wang评分≥10是失败的预测因素。持续的心动过速、呼吸急促、高碳酸血症和2小时后FiO2≥48.5%也是重要的预测因素。失败的常见原因是呼吸力增加（64.8%）和严重呼吸暂停（18.5%）。结论：HFNC失败的预测因素包括低体重、高初始FiO2、重度临床评分以及治疗早期持续的临床不稳定，有助于临床决策。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Archives De Pediatrie 医学-小儿科

CiteScore

2.80

自引率

5.60%

发文量

106

审稿时长

24.1 weeks

期刊介绍： Archives de Pédiatrie publishes in English original Research papers, Review articles, Short communications, Practice guidelines, Editorials and Letters in all fields relevant to pediatrics. Eight issues of Archives de Pédiatrie are released annually, as well as supplementary and special editions to complete these regular issues. All manuscripts submitted to the journal are subjected to peer review by international experts, and must: Be written in excellent English, clear and easy to understand, precise and concise; Bring new, interesting, valid information - and improve clinical care or guide future research; Be solely the work of the author(s) stated; Not have been previously published elsewhere and not be under consideration by another journal; Be in accordance with the journal''s Guide for Authors'' instructions: manuscripts that fail to comply with these rules may be returned to the authors without being reviewed. Under no circumstances does the journal guarantee publication before the editorial board makes its final decision. Archives de Pédiatrie is the official publication of the French Society of Pediatrics.