Case Reports Open access

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

Authors

Published
21 September 2021
Section
Case Reports
DOI
10.4081/ecj.2021.9615

Abstract

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.

Keywords

References

  1. 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
  2. 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
  3. 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
  4. 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
  5. 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
  6. 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
  7. 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
  8. 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
  9. 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
  10. 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
  11. 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
  12. 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
  13. 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

Metrics

Citations and online attention from Dimensions, Altmetric and PlumX.

PlumX Metrics

License

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.