Faktor Prediktif Kegagalan Hasil High Flow Nasal Cannula pada Anak dengan Gagal Napas Akut
Sari
Latar belakang. High Flow Nasal Cannula dapat membawa risiko keterlambatan saat intubasi diperlukan. Pentingnya memprediksi luaran HFNC agar eskalasi terapi dapat segera dilakukan.
Tujuan. Menganalisis nilai HR, RR, SpO2, pH, pCO2, HCO3, laktat, FiO2, rasio SF dan indeks ROX sebagai faktor prediktif kegagalan terapi HFNC pada anak dengan gagal napas akut.
Metode. Kohort retrospektif dilakukan di Unit Perawatan Intensif Anak/PICU Rumah Sakit Umum Daerah Dr. Moewardi pada bulan Desember 2023 sampai Februari 2024. Analisis data rekam medis menggunakan SPSS 23, nilai p<0,05 dianggap signifikan secara statistik.
Hasil. Peningkatan HR (nilai p=0,001; RR=39; IK95%:3,48-437,49), peningkatan RR (nilai p=0,09; RR=16,33; IK95%:2,19-121,42), penurunan SpO2 (nilai p=0,04; RR=7; IK95%:1,20-40,83) dan peningkatan laktat (nilai p=0,04; RR=6,50; IK95%:1,09-36,63) signifikan pada 1 jam setelah HFNC. Peningkatan HR signifikan pada 2 jam dan 4 jam setelah terapi HFNC (p=0,004; RR=17,33; IK95%:2,36-127,34 dan nilai p=0,04; RR=6,50; IK95%:1,09-38,63). Peningkatan HR merupakan faktor prediktif yang signifikan pada 1 jam dan 2 jam setelah terapi HFNC serta peningkatan RR pada 1 jam setelah HFNC berdasarkan uji multivariat (masing-masing p=0,04; RR=42,67; IK95%:1,18-1.518,62, nilai p=0,02; RR=15,29; IK95%:1,42-164,19, dan nilai p=0,04; RR=44,41; IK95%:1,24- 1.595,89).
Kesimpulan. Peningkatan HR dan peningkatan RR adalah faktor prediktif kegagalan terapi HFNC yang paling berpengaruh. Perlunya pemantauan ketat utamanya pada 1 jam setelah terapi HFNC sebagai pertimbangan eskalasi.
Kata Kunci
Teks Lengkap:
PDFReferensi
Slubowski D, Ruttan T. High-flow nasal cannula and noninvasive ventilation in pediatric emergency medicine. Pediatr Emerg Med Pract 2020;17:1-24.
Agarwal A, Basmaji J, Muttalib F, Granton D, Chaudhuri D, Chetan D, dkk. High-flow nasal cannula for acute hypoxemic respiratory failure in patients with COVID-19: systematic reviews of effectiveness and its risks of aerosolization, dispersion, and infection transmission. Can J Anaesth 2020;67:1217-48.
Kwon JW. High-flow nasal cannula oxygen therapy in children: a clinical review. Clin Exp Pediatr 2020;63:3-7.
Lodeserto FJ, Lettich TM, Rezaie SR. High-flow nasal cannula: mechanisms of action and adult and pediatric indications. Cureus 2018;10:3639.
Kang BJ, Koh Y, Lim CM, Huh JW, Baek S, Han M, dkk. Failure of high-flow nasal cannula therapy may delay intubation and increase mortality. Intensive Care Med 2015;41:623-32.
Franklin D, Babl FE, Schlapbach LJ, Oakley E, Craig S, Neutze J, dkk. A randomized trial of high-flow oxygen therapy in infants with bronchiolitis. N Engl J Med 2018;378:1121-31.
Beltramo F, Khemani RG. Definition and global epidemiology of pediatric acute respiratory distress syndrome. Ann Transl Med 2019;7:502.
Schouten LR, Veltkamp F, Bos AP, van Woensel JB, Serpa Neto A, Schultz MJ, dkk. Incidence and mortality of acute respiratory distress syndrome in children: a systematic review and meta-analysis. Crit Care Med 2016;44:819-29.
Khemani RG, Smith L, Lopez-Fernandez YM, Kwok J, Morzov R, Klein MJ, dkk; Pediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE) investigators; pediatric acute lung injury and sepsis investigators (PALISI) Network. paediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE): an international, observational study. Lancet Respir Med 2019;7:115-28.
Von Saint André-Von Arnim AO, Okeyo B, Cook N, Steere M, Roberts J, Howard CRA, dkk. Feasibility of high-flow nasal cannula implementation for children with acute lower respiratory tract disease in rural Kenya. Paediatr Int Child Health 2019;39:177-83.
Lee WY, Choi EK, Shin J, Lee EH, Choi BM, Hong YS. Risk factors for treatment failure of heated humidified high- flow nasal cannula as an initial respiratory support in newborn infants with respiratory distress. Pediatr Neonatol 2020;61:174-9.
Hota D, Jindal A. Dalam: Soans ST, Chawla N, penyunting. IAP textbook of pediatric and neonatal emergencies. New Delhi, India: Jaypee Brothers Medical Publishers; 2019.h.160-9.
Schneider J, Sweberg T. Acute respiratory failure. Crit Care Clin 2013;29:167-83.
Yaman A. High flow nasal oxygen therapy in pediatric intensive care unit. Bagcilar Med Bull 2021;6:42-7.
Krachman JA, Patricoski JA, Le CT, Park J, Zhang R, Gong KD, dkk. Predicting flow rate escalation for pediatric patients on high flow nasal cannula using machine learning. Front Pediatr 2021;9:734753.
Kurosawa H, Shiima Y, Miyakoshi C, Nezu M, Someya M, Yoshida M, dkk. The association between prehospital vital signs of children and their critical clinical outcomes at hospitals. Sci Rep 2022;12:5199.
Ayd?n O, Ayd?n EA, Birbilen AZ, Tek?am Ö. Predictive factors of high-flow nasal cannula oxygen therapy failure in children with respiratory distress treated in a pediatric emergency department. Turk J Pediatr 2021;63:1012-9.
Mayfield S, Bogossian F, O'Malley L, Schibler A. High-flow nasal cannula oxygen therapy for infants with bronchiolitis: pilot study. J Paediatr Child Health 2014;50:373-8.
Roca O, Messika J, Caralt B, García-de-Acilu M, Sztrymf B, Ricard JD, dkk. Predicting success of high-flow nasal cannula in pneumonia patients with hypoxemic respiratory failure: The utility of the ROX index. J Crit Care 2016;35:200-5.
Hough JL, Pham TM, Schibler A. Physiologic effect of high- flow nasal cannula in infants with bronchiolitis. Pediatr Crit Care Med 2014;15:214-9.
Asseri AA, AlQahtani YA, Alhanshani AA, Ali GH, Alhelali I. Indications and safety of high flow nasal cannula in pediatric intensive care unit: retrospective single center experience in Saudi Arabia. Pediatric Health Med Ther 2021;12:431-37.
Chang CC, Lin YC, Chen TC, Lin JJ, Hsia SH, Chan OW, dkk. High-flow nasal cannula therapy in children with acute respiratory distress with hypoxia in a pediatric intensive care unita single center experience. Front Pediatr 2021;9:664180.
Luo J, Duke T, Chisti MJ, Kepreotes E, Kalinowski V, Li J. Efficacy of High-Flow Nasal Cannula vs Standard Oxygen Therapy or Nasal Continuous Positive Airway Pressure in Children with Respiratory Distress: A Meta-Analysis. J Pediatr 2019;215:199-208.e8.
Sunkonkit K, Kungsuwan S, Seetaboot S, Reungrongrat S. Factors associated with failure of using high flow nasal cannula in children. Clin Respir J 2022;16:732-9.
Saelim K, Thirapaleka B, Ruangnapa K, Prasertsan P, Anuntasenenee W. Predictors of high-flow nasal cannula failure in pediatric patients with acute respiratory distress. Clin Exp Pediatr 2022;65:595-601.
Telechea H, Pardo L, Giachetto G, Amilivia M, Bartaburu C, Cabilon A, dkk. Failure predictors with oxygen therapy by high-flow nasal catheter in children under 2 years of age with acute lower respiratory infections. Andes Pediatr 2023;94:444-52.
Dunbar KS, Fox SN, Thomas JF, Brittan MS, Soskolne G, Cotter JM. When to transfer: predictors of pediatric high flow nasal cannula failure at a community hospital. Hosp Pediatr 2023;14:45-51.
Nascimento MS, Quinto DER, Zamberlan GC, Santos AZD, Rebello CM, Prado CD. High-flow nasal cannula failure: can clinical outcomes determine early interruption? Einstein (Sao Paulo) 2021;19:846.
Ileri G, Zengin N, Bal A. Evaluation of efficacy and failure of high flow nasal cannula therapy in paediatric emergency service and paediatric intensive care unit. Med Sci Discov 2022;9:243-8.
Heidemann SM, Nair A, Bulut Y, Sapru A. Pathophysiology and management of acute respiratory distress syndrome in children. Pediatr Clin North Am 2017;64:1017-37.
Bos LDJ, Ware LB. Acute respiratory distress syndrome: causes, pathophysiology, and phenotypes. Lancet 2022;400:1145-56.
Prasad S, O’Neill S. Respiratory failure. Surgery (Oxf) 2021;39:654-59.
Venanzi A, Di Filippo P, Santagata C, Di Pillo S, Chiarelli F, Attanasi M. Heated humidified high-flow nasal cannula in children: state of the art. Biomedicines 2022;10:2353.
Hammer J. Acute respiratory failure in children. Paediatr Respir Rev 2014:64-9.
Faulhaber M, Gatterer H, Haider T, Linser T, Netzer N, Burtscher M. Heart rate and blood pressure responses during hypoxic cycles of a 3-week intermittent hypoxia breathing program in patients at risk for or with mild COPD. Int J Chron Obstruct Pulmon Dis 2015;10:339-45.
Bickler PE, Feiner JR, Lipnick MS, McKleroy W. "Silent" presentation of hypoxemia and cardiorespiratory compensation in COVID-19. Anesthesiology 2021;134:262-9.
Li Y, Li C, Chang W, Liu L. High-flow nasal cannula reduces intubation rate in patients with COVID-19 with acute respiratory failure: a meta-analysis and systematic review. BMJ Open 2023;13:e067879.
Niczewski M, Gaw?da S, Kluszczyk P, Rycerski M, Sygu?a D, Danel A, dkk. The predictive role of lactate in the emergency department in patients with severe dyspnea. Emerg Med Int 2024:6624423.
Deng XJ, Zou Y, Wu J, Liang Y, Gu SY. The effect of blood lactate and NT-proBNP predict the survival in patients with invasive mechanical ventilation. Ann Transl Med 2020;8:458.
Lu Y, Guo H, Chen X, Zhang Q. Association between lactate/albumin ratio and all-cause mortality in patients with acute respiratory failure: A retrospective analysis. PLoS One 2021;16:e0255744.
Polo TCF, Miot HA. Use of ROC curves in clinical and experimental studies. J Vasc Bras 2020;19:e20200186.
Foucher CD, Tubben RE. Lactic Acidosis. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. Didapat dari: https://www.ncbi.nlm.nih.gov/books/NBK470202/
Choudhary R, Sitaraman S, Choudhary A. Lactate clearance as the predictor of outcome in pediatric septic shock. J Emerg Trauma Shock 2017;10:55-9.
Loomba RS, Farias JS, Villarreal EG, Flores S. Serum Lactate and Mortality during Pediatric Admissions: Is 2 Really the Magic Number? J Pediatr Intensive Care 2022;11:83-90.
Demelo-Rodríguez P, Olmedo Samperio M, Gaitán Tocora DG, Cano Ballesteros JC, Andueza Lillo JA. High-flow nasal cannula oxygen therapy: preliminary study in hospitalized patients. Arch Bronconeumol 2015;51:657-9.
Gunning KEJ. Pathophysiology of Respiratory Failure and Indications for Respiratory Support. Surg (Oxford) 2003;21:72-6.
Kim GE, Choi SH, Park M, Jung JH, Lee M, Kim SY, dkk. SpO2/FiO2 as a predictor of high flow nasal cannula outcomes in children with acute hypoxemic respiratory failure. Sci Rep 2021;11:13439.
Mayordomo-Colunga J, Pons M, López Y, José Solana M, Rey C, Martínez-Camblor P, dkk. Predicting non-invasive ventilation failure in children from the SpO?/FiO? (SF) ratio. Intensive Care Med 2013;39:1095-103.
D'Alessandro M, Vanniyasingam T, Patel A, Gupta R, Giglia L, Federici G, Wahi G. Factors associated with treatment failure of high-flow nasal cannula among children with bronchiolitis: a single-centre retrospective study. Paediatr Child Health 2020;26:e229-35.
Manley BJ, Owen LS, Doyle LW, Andersen CC, Cartwright DW, Pritchard MA, dkk. High-flow nasal cannulae in very preterm infants after extubation. N Engl J Med 2013;369:1425-33.
Iplik G, Yildizdas D, Yontem A. Clinical factors of high- flow nasal cannula oxygen success in children. J Pediatr Intensive Care 2021;12:71-8.
Roussos C, Koutsoukou A. Respiratory failure. Eur Respir J Suppl 2003;47:3s-14s.
Zhang D, She J, Zhang Z, Yu M. Effects of acute hypoxia on heart rate variability, sample entropy and cardiorespiratory phase synchronization. Biomed Eng Online 2014;13:73.
Lee JM, Pinsky MR. Cardiovascular interactions in respiratory failure. Dalam: Webb A, Angus D, Finfer S, Gattinoni L, Singer M, penyunting. Oxford textbook of critical care. Second Edition. Oxford, United Kingdom: Oxford University Press 2016.h.399-402.
Lun CT, Leung CK, Shum HP, So SO. Predictive factors for high-flow nasal cannula failure in acute hypoxemic respiratory failure in an intensive care unit. Lung India 2022;39:5-11.
Vo P, Kharasch VS. Respiratory failure. Pediatr Rev 2014;35:476-84; quiz 485-6.
El-Khatib MF. High-flow nasal cannula oxygen therapy during hypoxemic respiratory failure. Respir Care 2012;57:1696-8.
DOI: http://dx.doi.org/10.14238/sp26.4.2024.202-11
Refbacks
- Saat ini tidak ada refbacks.
##submission.copyrightStatement##
##submission.license.cc.by-nc-sa4.footer##
Email: editorial [at] saripediatri.org
Sari Pediatri diterbitkan oleh Badan Penerbit Ikatan Dokter Anak Indonesia
Ciptaan disebarluaskan di bawah Lisensi Creative Commons Atribusi-NonKomersial-BerbagiSerupa 4.0 Internasional.