NEW YORK (Reuters Health) – The Optiflow nasal cannula may improve breathing in infants and children who have severe obstructive sleep apnea syndrome (OSAS) or chronic respiratory failure and are on continuous positive airway pressure (CPAP), a small case series from Belgium suggests.
“In this study, the Optiflow (Fisher and Paykel Healthcare, Auckland, New Zealand) nasal-cannula-like device instead of a mask to deliver CPAP was well tolerated and effective,” Dr. Zarmina Ehsan, a pediatric pulmonologist and sleep specialist at Children’s Mercy Kansas City in Kansas City, Missouri, told Reuters Health.
“One of the biggest challenges with CPAP use in young infants and children is finding a mask that fits well and is tolerated. CPAP is one of the standard therapies for severe OSA in children, and children with OSA frequently are intolerant to regular CPAP masks,” Dr. Ehsan, who was not involved in the study, said in an email.
Dr. Stijn Verhulst of Antwerp University Hospital in Edegem, Belgium, and colleagues conducted a pilot study of 9 children (ages 7 months to 15 years) treated with the Optiflow device at one academic medical center. Eight had OSAS.
Nasal mask intolerance prompted use of the Optiflow in 8 children; a nasal lesion was the precipitating factor in one child. Most of the children had already tried one or two other nasal interfaces before the Optiflow.
The Optiflow nasal cannula was connected to a CPAP device, the Trilogy100 ventilator (Philips, Amsterdam, the Netherlands), using a pressure line. The size of each cannula was recommended by the manufacturer based on the patient’s age.
As reported online December 5 in Sleep Medicine, adding the Optiflow cannula led to a significant decrease in the obstructive apnea-hypopnea index (AHI), from a median of 30.3 to 5.0, and in the total AHI (from 37.1 to 10.5). It also yielded a nonsignificant trend toward increased minimal oxygen saturation. The authors do not mention how long the participants used the Optiflow before improvement data were recorded.
They characterize the children’s compliance with the Optiflow as “very good,” ranging from 240 to 736 minutes per day. Only one child had difficulty with the device.
And they advise that the Optiflow “should not be used for children who require bilevel ventilation because of insufficient triggering.”
Dr. Ehsan highlighted that the study was a small case series and that “more robust research evidence is needed prior to using the Optiflow for standard clinical care.”
Dr. David Gozal, a specialist in pediatric sleep disorders at University of Chicago Medicine, who also was not involved in the study, told Reuters Health by email, “The lack of adequate interfaces between CPAP machines and young children’s faces has prompted a variety of strategies to enable delivery of this therapy to the youngest and most vulnerable patients. To this effect, new masks have recently come to the market, and custom fabrication of masks that are molded to the face of the child using 3-D printing are emerging as options that will likely become standard procedure in the near future.”
“This case series examined the feasibility of the nasal cannula but did not compare adherence, outcomes, or any other elements routinely used for non-inferiority assessments of a new technology versus the usual standard,” he advised. “Unless such success can be transferred to many other centers with similar results, the generalizability of the reported approach remains speculative.”
Dr. Gozal also cautioned, “The cannula was used with a very sophisticated ventilator and not with the standard CPAP machines that are used in the market. As such, extrapolation of the successful implementation reported here cannot be transferred to other CPAP machines.”
He recommended, however, “If routine nasal or face masks or nasal prongs fail in children for delivery of CPAP therapy, you may wish to consider a trial of this nasal cannula.”
The study’s corresponding author did not respond to requests for comment.
The study authors and Dr. Gozal report no conflicts of interest. Dr. Ehsan also identified no pertinent conflicts but noted that, at her hospital, she is involved with a study of the Optiflow to treat children with OSA.
SOURCE: http://bit.ly/2zl807O
Sleep Med 2017.
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