PHYSIOLOGIC EFFECTS OF HIGH-FLOW NASAL CANNULA IN INFANTS WITH BRONCHIOLITIS
Hough JL, Pham TM, Schibler A. Pediatr Crit Care Med. 2014;16(5):e214-e219.
The researchers in this prospective observational study sought to assess the effect of high-flow nasal cannula flow on end-expiratory lung volume, continuous distending pressure, and regional ventilation distribution in infants younger than 12 months with bronchiolitis (n = 13). The infants were measured on flow rate applied at 2 and 8 L/min though a high-flow nasal cannula system.
Distribution of ventilation was measured with regional electrical impedance amplitudes and end-expiratory lung volume using electrical impedance tomography. Changes in the distending pressure were measured from the esophagus via a nasogastric tube. Physiologic variables were also recorded. These measurements included inspired oxygen (Fio2), respiratory rate (RR), heart rate (HR), and oxygen saturation as measured by pulse oximetry (SpO2). High-flow nasal cannula delivered at 8 L/min resulted in significant increases in global and anterior end-expiratory lung volume (P < .01) and improvements in the physiological variable of RR, SpO2, and FIO2 when compared with flows of 2 L/min.
The authors conclude that in infants with bronchiolitis, high-flow nasal cannula oxygen/air delivered at 8 L/min results in increases in end-expiratory lung volume and RR, FIO2, and SpO2.
SURVEY ON STATED TRANSFUSION PRACTICE IN PICUS
Du Pont-Thibodeau G, Tucci M, Ducreut T, Lacroix J. Pediatr Crit Care Med. 2014;15(5):409-416.
The objective of this self-administered questionnaire that was administered to intensivists and fellows in pediatric critical care medicine sought to analyze the red blood cell transfusion practice patterns among pediatric intensivists following new evidence advocating for restrictive transfusion policy. The questionnaires were scenario-based surveys sent to physicians in North America and European intensivists.
Respondents (n = 97) were asked to report their decisions with red blood cell transfusions in stable critical ill children with bronchiolitis, septic shock, trauma, or tetralogy of Fallot repair scenarios. A similar survey was done in 1997, and the results were compared. The authors found that for all clinical scenarios, there was a trend toward a more restrictive transfusion approach. A restrictive strategy was adopted by 55.7% compared with 37% in 1997 with the scenario of bronchiolitis, 8.3% versus 3.4% with septic shock, 38.1 versus 9.0% with trauma, and 16% versus 7.9 with tetralogy of Fallot repair.
The researchers concluded that the stated transfusion practice patterns of pediatric intensivists appear to be evolving toward a more restrictive approach. The authors also state that there is a need for further research in this area.