Serious Air Leak Syndrome Complicating High-Flow Nasal Cannula Therapy: A Report of 3 Cases
Serious Air Leak Syndrome Complicating High-Flow Nasal Cannula Therapy: A Report of 3 Cases
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DOI：
10.1542/peds.2011-3767
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发表时间：
2013-03-01
期刊：
影响因子：
8
通讯作者：
Prodhan, Parthak
中科院分区：
文献类型：
--
作者：
Hegde, Satyanarayan;Prodhan, Parthak
尽管缺乏临床安全性数据，但加热加湿高流量鼻插管（HHFNC）治疗越来越多地被用作儿科正压通气的替代方案。HHFNC的这种使用是“标签外”的，因为美国食品和药物管理局对这些设备的批准仅用于空气加湿，而不是作为提供正扩张压力的方式。我们首次描述了3例与HHFNC治疗相关的严重漏气病例。第一个孩子是一个以前健康的2个月大的男婴呼吸道合胞病毒毛细支气管炎谁开发了右气胸在第5天的疾病在8升每分钟（lpm）。他随后需要插管和通气14天。第二个病例涉及一名健康的16岁脑瘫男孩，他患上了肺气肿并死于并发症。他正在接受20 lpm HHFNC治疗时发生肺气肿。第三例病例涉及一名22个月大的既往健康男孩，他继发于滥用而发生硬膜下血肿。他在接受6 lpm流量的HHFNC时发生右侧气胸，需要放置胸管。这些病例强调，在将HHFNC用于为儿童提供正扩张压的标签外适应症时，尤其是在流量高于患者每分钟通气量时，需要极其谨慎。迫切需要一项更详细的研究，专门研究与HHFNC相关的严重不良事件。儿科2013;131：e939-e944
Despite the absence of clinical safety data, heated, humidified high-flow nasal cannula (HHFNC) therapy is increasingly being used as an alternative to positive-pressure ventilation in pediatrics. This use of HHFNC is "off label" because the US Food and Drug Administration's approval for these devices was only for air humidification and not as a modality to provide positive distending pressure. For the first time we describe 3 cases who developed serious air leaks related to HHFNC therapy. The first child was a previously healthy 2-month-old male infant with respiratory syncytial virus bronchiolitis who developed a right pneumothorax on day 5 of his illness at 8 liters per minute (lpm). He subsequently required intubation and ventilation for 14 days. The second case involved an otherwise healthy 16-year-old boy with cerebral palsy who developed pneumomediastinum and died of its complications. He was receiving 20 lpm HHFNC therapy when he developed pneumomediastinum. The third case involved a 22-month-old, previously healthy boy who developed subdural hematoma secondary to abuse. He developed a right pneumothorax while receiving HHFNC at a flow of 6 lpm, requiring chest tube placement. These cases emphasize the need for extreme caution while using HHFNC for the off-label indication of providing positive distending pressure in children, especially at flows higher than the patient's minute ventilation. A more detailed study to specifically look at the serious adverse events related to HHFNC is urgently needed. Pediatrics 2013;131:e939-e944