Heated High Flow Nasal Cannula Use at the Hospital for Sick Children: A Retrospective Chart Review

Abstract

SESSION TITLE: Pediatrics SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: Introduction: Heated high flow nasal cannula (HFNC) therapy is a method of providing oxygen using flow rates higher than that used with traditional oxygen therapy. There is a dearth of evidence regarding the efficacy, effectiveness and safety of HFNC in the paediatric population. Objectives: to describe HFNC therapy at SickKids, including predictors of treatment failure. METHODS: Retrospective chart review of patients treated with HFNC in the Critical Care Unit (CCU), wards and Emergency Department between September 1st 2013 and January 31st 2016. Patients were categorized as non-responders (NR) (intolerance/agitation, transition to non-invasive (NIV) or invasive mechanical ventilation (IV), transfer to the CCU, cardiac arrest or death) or responders (R) (all other scenarios). Analysis: descriptive statistics; R vs. NR using chi-square (categorical), two-sample t-test (continuous) and Wilcoxon rank sums tests (skewed variables). Significant predictors in past literature and deemed important by the clinical respiratory therapists (RTs) were included in a multiple logistic regression model for predicting NR. RESULTS: 357 patients used HFNC: n=158(44%) females; n=208(58%) after extubation; n=139 (39%) for respiratory distress or work of breathing; mean(SD) age=2.1(2.9) years; duration of therapy=57.6(84.3) days. N=117(33%) were NRs, the majority requiring NIV or IV (98(84%)). Significant associations of NR: change in flowrate/kg in the first 4 hours (NR vs. R: 0.05(0.1) vs. -0.08(0.05) lpm/kg), p=0.05; change in respiratory rate (RR) in the first 4 hours (-5.8(3.3) vs. 0.2(2.4) bpm), p=0.04; hospital LOS (111.4(17.9) vs. 65.6(9.9) days), p=0.02. CONCLUSIONS: The majority of children at SickKids were placed on HFNC after extubation or due to respiratory distress. An increased flowrate and decreased RR in the first 4 hours, and longer hospital LOS was associated with failure of HFNC. CLINICAL IMPLICATIONS: Monitoring these parameters may help RTs anticipate HFNC failure and avoid higher forms of respiratory support. This may help inform HFNC protocols for initiation, weaning and discontinuation. DISCLOSURE: The following authors have nothing to disclose: Mika Nonoyama, Katherine Reise, Jason Macartney, Cameron Wright No Product/Research Disclosure Information