https://doi.org/10.4081/ecj.2021.9615

Subcutaneous emphysema of the neck as a complication of high flow nasal cannula therapy in children: a case report

Vol. 17 No. 3 (2021)
Submitted: 15 January 2021
Accepted: 15 June 2021
Published: 21 September 2021
Bronchiolitis, respiratory syncyctial virus (MeSH), respiratory therapy (MeSH), mediastinal emphysema (MeSH)
Abstract Views: 871
PDF: 225
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Luca Pierantoni
Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy.
Arianna Dondi
arianna.dondi@gmail.com
http://orcid.org/0000-0002-7516-243X
Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy.
Carlotta Biagi
Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy.
Andrea Scozzarella
Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy.
Federica Camela
Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy.
MArcello Lanari
Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy.

High Flow Nasal Cannula (HFNC) is a noninvasive technique for respiratory support increasingly used in the pediatric wards for the management of respiratory failure. Few data are reported about the safety of HFNC. We describe the case of a 3-months-old infant admitted for acute bronchiolitis Respiratory Syncyctial Virus-related and treated with HFNC for severe respiratory distress. 12 hours after the beginning of HFNC a subcutaneous swelling of the neck, attributable to subcutaneous emphysema, became clinically evident. Radiological imaging showed pneumomediastinum with air leaking up to the neck. Patient was moved to PICU where he further worsened due to a mediastinal shift requiring drainage and mechanical ventilation. He was then progressively weaned from ventilation and was discharged from the hospital. Pneumomediastinum may occur during HFNC, particularly in moderate-severe cases of acute bronchiolitis. Patients undergoing HFNC should be strictly monitored in order to promptly recognize this complication and treat the child appropriately.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Crossref
Scopus
Google Scholar
Europe PMC
McKiernan C, Chua LC, Visintainer PF, Holley A. High flow nasal cannulae therapy in infants with bronchiolitis. J Pediatr 2010;156:634-8. DOI: https://doi.org/10.1016/j.jpeds.2009.10.039
Bressan S, Balzani M, Krauss B, et al. High-flow nasal cannula oxygen for bronchiolitis in a pediatric ward: A pilot study. Eur J Pediatr 2013;172:1649-56. DOI: https://doi.org/10.1007/s00431-013-2094-4
Von S, Beggs S, Wong ZH, et al. High-flow nasal cannula therapy for infants with bronchiolitis. Cochrane Database Syst Rev 2014;1:CD009609. DOI: https://doi.org/10.1002/14651858.CD009609.pub2
Mikalsen IB, Davis P, Øymar K. High flow nasal cannula in children: a literature review. Scand J Trauma Resusc Emerg Med 2016;24:93. DOI: https://doi.org/10.1186/s13049-016-0278-4
Hutchings F, Hilliard TN, Davis PJ. Heated humidified high-flow nasal cannula therapy in children. Arch Dis Child 2014:1-5. DOI: https://doi.org/10.1136/archdischild-2014-306590
Hegde S, Prodhan P. Serious air leak syndrome complicating high-flow nasal cannula therapy: a report of 3 cases. Pediatrics 2013;131:e939-44. DOI: https://doi.org/10.1542/peds.2011-3767
Ralston SL, Lieberthal AS, Meissner HC, et al. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics 2014;134:e1474-502. Erratum in: Pediatrics 2015;136:782. DOI: https://doi.org/10.1542/peds.2015-2862
Mayfield S, Jauncey-Cooke J, Hough JL, et al. High-flow nasal cannula therapy for respiratory support in children. Cochrane Database Syst Rev 2014;2014:CD009850. DOI: https://doi.org/10.1002/14651858.CD009850.pub2
Silva C, Almeida AF, Ferraz C, et al. Spontaneous pneumothorax with subcutaneous emphysema: a rare complication of respiratory syncytial virus infection. J Clin Med Res 2016;8:260-2. DOI: https://doi.org/10.14740/jocmr2353w
Hasan RA, Habib RH. Effects of flow rate and airleak at the nares and mouth opening on positive distending pressure delivery using commercially available high-flow nasal cannula systems: a lung model study. Pediatr Crit Care Med 2011;12:e29-33. DOI: https://doi.org/10.1097/PCC.0b013e3181d9076d
Wilkinson D, Andersen C, O’Donnel CP, et al. High flow nasal cannula for respiratory support in preterm infants. Cochrane Database Syst Rev 2016;2:CD006405 DOI: https://doi.org/10.1002/14651858.CD006405.pub3
Kepreotes E, Whitehead B, Attia J, et al. High-flow warm humidified oxygen versus standard low-flow nasal cannula oxygen for moderate bronchiolitis (HFWHO RCT): an open, phase 4, randomised controlled trial. Lancet 2017;389:930–9. DOI: https://doi.org/10.1016/S0140-6736(17)30061-2
Franklin D, Babl FE, Schlapbach LJ, et al. A randomized trial of high-flow oxygen therapy in infants with bronchiolitis. N Engl J Med 2018;378:1121-31. DOI: https://doi.org/10.1056/NEJMoa1714855

How to Cite

Pierantoni, L., Dondi, A., Biagi, C., Scozzarella, A., Camela, F., & Lanari, M. (2021). Subcutaneous emphysema of the neck as a complication of high flow nasal cannula therapy in children: a case report. Emergency Care Journal, 17(3). https://doi.org/10.4081/ecj.2021.9615

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.