High-Flow Nasal Cannula Therapy in Children With Acute Respiratory Distress With Hypoxia in A Pediatric Intensive Care UnitA Single Center Experience.

Chih-Ching Chang,Tzu-Chun Chen,Jainn-Jim Lin,Oi-Wa Chan,En-Pei Lee,Shao-Hsuan Hsia,Yi-Chen Lin

doi:10.3389/fped.2021.664180

Abstract

Aim: High-flow nasal cannulas (HFNCs) show potential in the application of positive pressure, improving gas exchange, and decreasing work of breathing in patients with acute respiratory distress. The aims of this study were to elucidate the indications for HFNC therapy in children of all ages and diagnoses, and to evaluate the efficacy and risk factors for failure of HFNC therapy in children with acute respiratory distress with hypoxia in a pediatric intensive care unit.Methods: We conducted this retrospective cohort study at a tertiary pediatric intensive care unit between January 1, 2018 and December 31, 2020. All children, from 1 month to 18 years of age, with acute respiratory distress with hypoxia and HFNC therapy were eligible. The clinical data were reviewed.Results: One hundred and two children met the eligibility criteria for the study, of whom 57 (55.9%) were male, and the mean age was 7.00 6.79 years. Seventy-eight (76.5%) of the children had underlying disorders. The most common indications for the use of HFNC therapy were pneumonia (40, 39.2%), sepsis-related respiratory distress (17, 16.7%), and bronchiolitis (16, 15.7%). The failure rate was 15.7% (16 of 102 children). Higher initial and maximum fraction of inspiration O2 levels and lower initial and lowest SpO2/FiO2 (S/F) ratio were early and possible signs of failure requiring escalation of respiratory support.Conclusion: In our population, we found that HFNC therapy could be initiated as the first-line therapy for various etiologies of acute respiratory distress with hypoxia in a pediatric intensive care unit and for all age groups.

Highlights

Acute respiratory distress is the most common cause of pediatric intensive care unit admission
High-flow nasal cannulas (HFNCs) therapy has been used in infants with respiratory distress syndrome and infants with bronchiolitis, and it has been shown to decrease respiratory distress and intubation rates, increase patient comfort and ease of use compared with face masks or traditional cannulas, and shorten the length of stay in pediatric intensive care units (ICUs) [12,13,14,15]
102 children with acute respiratory distress were managed with HFNC therapy during their pediatric ICU stay (Figure 2)

Summary

Introduction

Acute respiratory distress is the most common cause of pediatric intensive care unit admission. Invasive mechanical ventilation is an established effective supportive therapy for acute respiratory distress. It is associated with increased risks of nosocomial infections, lung and airway injuries, length of stay, and sedation-related complications [1,2,3]. HFNC therapy has been used in infants with respiratory distress syndrome and infants with bronchiolitis, and it has been shown to decrease respiratory distress and intubation rates, increase patient comfort and ease of use compared with face masks or traditional cannulas, and shorten the length of stay in pediatric intensive care units (ICUs) [12,13,14,15]

Objectives

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Results

Conclusion