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1/8/13news article

local hospital’s research predicts success or failure of less invasive breathing therapy in infants with viral bronchiolitis

One local physician is making strides at predicting what patients will best respond to a less invasive respiratory treatment, called high-flow, high-humidity nasal cannula therapy.  Patricia Abboud, MD, a pediatric intensivist in the pediatric intensive care unit (PICU) at Dayton Children’s and associate professor of pediatrics at the Wright State University Boonshoft School of Medicine, recently published the findings of a three-year retrospective research study in the journal of Pediatric Critical Care Medicine.  

With this type of therapy, prongs are inserted into a patient’s nose and the gas is warmed and humidified before delivered to a patient, making the gas more tolerable and more supportive of the patient’s natural breathing. Overall, this therapy is known as less invasive than intubation (inserting a tube down a patient’s throat). The purpose of the study was to identify the patient variables most likely to respond to noninvasive positive pressure ventilation in patients with viral bronchiolitis.

According to Dr. Abboud, bronchiolitis is the number two reason for admission to Dayton Children’s, so being able to predict whether an infant with viral bronchiolitis will respond positively to high-flow, high-humidity nasal cannula therapy gives physician’s valuable insight when developing a patient’s care treatment plan. 

“Intubation requires sedating the patient and also carries the risk of damage to the patient’s airway and the possibility of ventilator-associated pneumonia,” says Dr. Abboud. “Therefore, knowing the likelihood of a patient responding to a less invasive therapy like high-flow, high humidity nasal cannula therapy is beneficial.”

Dr. Abboud, along with Patrick Roth, BS, RRT, RCP; Cheri Skiles, RN, BSN, and Adrienne Stolfi, MSPH, studied 113 patients through retrospective chart review.

Findings from the research study:

  • 86 percent of the 113 patients in the pediatric intensive care unit (PICU) met the inclusion criteria for the high-flow, high-humidity positive pressure ventilation. All patients were 12 months old and younger, received a diagnosis of viral bronchiolitis and were in respiratory distress.
  • The patient’s age, sex, ethnicity, or history of prematurity had no impact on the patient’s risk of failing the high-flow, high-humidity ventilation therapy.
  • The biggest indicators of a patient not responding to high-flow, high-humidity nasal cannula therapy was a lower respiratory rate and higher rate of exhaled carbon dioxide. Patients who were non-responsive also had a higher Pediatric Risk of Mortality Scores in the first 24 hours.

“Knowing the predictors of the potential success or failure of high-flow, high-humidity nasal cannula therapy helps us more effectively manage a patient’s care treatment plan,” says Dr. Abboud. “It allows us to use the most effective and least invasive techniques to treat infants with viral bronchiolitis, which eases parents’ minds.”

Today, Dr. Abboud’s work in child health research continues with a prospective study on high-flow, high-humidity nasal cannula therapy, expected to span three to five years. This work strengthens Dayton Children’s quest for improving patients’ outcomes through new knowledge, helping physicians to adapt their bedside protocol – based on our own research and that of the medical and scientific community.

About Wright State University Boonshoft School of Medicine

Located in Dayton, Ohio, the community-based Wright State University Boonshoft School of Medicine is affiliated with seven major teaching hospitals in southwest Ohio. In addition to providing medical education leading to the M.D., M.D./Ph.D., M.D./M.B.A. or M.D./M.P.H. degree, the medical school provides residency training in 13 medical specialties and continuing medical education programs for the community’s practicing physicians. Its nationally recognized research programs include centers of excellence in genomics, neuroscience, substance abuse and treatment and human growth and development.

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