The Effect Of Clinical Treatment With Heated,Humidified High-flow Nasal Cannula On Moderate And Severe Bronchiolitis

Objective Observe the therapeutic efficacy and safety of humidified high flow nasal cannula(HHFNC)in children with moderate and severe bronchiolitis,to explore the clinical application of HHFNC in bronchiolitis.Methods A single-center,prospective,clinical observational study of children with moderate and severe bronchiolitis who satisfy the inclusion criteria at the pediatric intensive care unit of the Affiliated Hospital of Qingdao University from September 2016to September 2017,randomly assigned HHFNC treatment group and nCPAP treatment group;record heart rate(HR),respiratory rate(RR),percutaneous oxygen saturation(SpO2),and Partial pressure(PaO2),arterial carbon dioxide partial pressure(PaCO2),pH value before arterial oxygen and after treatment 6h,12h,24h,recording time of disappearance of lung rales in children,time of non-invasive ventilation,complications,and need for invasive ventilation,neonatal pain and The discomfort scale recorded the comfort of the two groups of children.SPSS22.0 statistical software was used for data analysis and statistical processing.Results(1)Fifty-two children were enrolled in this study.Eight patients with severe underlying disease were excluded.In the final HHFNC group 23 cases and nCPAP group21.There were no statistical differences in sex,gestational age,age,weight,etiology,duration of admission,major clinical signs and symptoms,radiographs,pretreatment heart rate,respiration,transcutaneous oxygen saturation,and blood gas index(P>0.05);(2)HHFNC group of children were significantly improved in various clinical indicators and blood gas indicators;after 6h two groups HR,SpO2,pH,PaO2 no significant difference(P>0.05),RR,PaCO2 in HHFNC group had statistically significant difference(P<0.05);after 12h,the HR,RR,SpO2,pH,Pa O2,PaCO2 of HHFNC group were better than nCPAP.The difference was statistically significant(P<0.05);after 24 h there was no difference in HR,SpO2,Pa O2,PaCO2 between the two groups(P>0.05),RR and pH of HHFNC group were better than that of nCPAP(P<0.05);There was no significant difference before removal of noninvasive assisted ventilation(P>0.05).(3)The time of lung rales disappearance in the two groups,HHFNC group(4.95±0.86)days,nCPAP group(5.28±1.01)days,the difference was no significant(t=1.080,P=0.287);(4)Non-invasive ventilation time between two groups,HHFNC group(49.24±10.78)h,nCPAP(52.00±9.82)h,there was no difference(t=0.831,P=0.412).(5)Two groups EDIN scale was recorded:HHFNC group 4.23±0.51,nCPAP group 4.78±0.63,the difference was significant(t=2.979,P=0.005);(6)The complications in two groups,One case(4.3%)of facial skin lesions in the HHFNC group and 7 cases(33.3%)of the nCPAP group,statistically significant differences(x~2=4.404,P=0.036);3 cases of nasal injury in the HHFNC group(13.0%),nCPAP 9 cases(42.9%),the difference was statistically significant(x~2=4.919,P=0.027);HHFNC treatment group children with abdominal distension in 4 cases(17.4%),nCPAP 10 cases(47.6%),the difference was statistically significant(x~2=4.623,P=0.032);the respiratory parameters were continuously adjusted in the early stage of non-invasive assisted ventilation,2 patients in the HHFNC group.3patients in nCPAP group,there was no significant difference(x~2=0.012,P=0.914).Among the 8 patients were excluded with other diseases that,3 had congenital heart disease,2 had bronchopulmonary dysplasia,2 had a chromosomal disorder,and 1 had a genetic metabolic disease.We also gave HHFNC assisted ventilation with the informed consent of the parents.Under the comprehensive treatment of respiratory support,the clinical symptoms were relieved and discharged from the hospital.Only one patient with facial skin lesions and one patient with abdominal distension.No invasive mechanical ventilation in children.Because of the large number of interference factors and the small sample size,no clinical controlled study was conducted.Conclusion 1.HHFNC compared with nCPAP,both groups can improve the clinical symptoms and blood gas index of children with moderate-severe bronchiolitis,improve the oxygenation of children and ventilatory function;2.HHFNC reduce the respiratory frequency,carbon dioxide retention was significant than nCPAP;3.Compared with nCPAP,HHFNC can reduce the incidence of facial skin,nose damage and abdominal distension in children.There is no difference in reducing invasive mechanical ventilatio.4.Application of HHFNC Children with bronchiolitis are comfortable and easy to accept.