P0275 / #754: HIGH-FLOW NASAL CANNULA FOR INFANT ACUTE RESPIRATORY FAILURE OUTSIDE THE PEDIATRIC INTENSIVE CARE UNIT. DESCRIPTION OF A REGIONAL PROTOCOL IMPLEMENTATION.

Abstract

Aims & Objectives: Each winter, infants with acute lower respiratory infections (ALRI) stress Buenos Aires city public health system resources. Since 2017, the Maternal-Child Health Department of the city progressively included high-flow nasal cannula (HFNC) therapy in ALRI treatment protocol in general wards from 6 hospitals (three in 2017, six in 2018-2019). Objective. To describe patient outcomes of this experience and explore potential factors related to treatment failure. Methods: Prospective, descriptive study with infants <18 months-old hospitalized for ALRI between June-September of 2017-2019. Only 2017 data has been published previously. All children unable to reach pre-specified low-flow therapeutic targets received HNFC therapy. Failure was defined as ICU admission. Variables are expressed as count (percentage) or median (interquartile range). Comparisons were made with Fisher’s exact test or Wilcoxon rank-sum test. Results: Along the three-year period 1710 patients were registered with 39.8%, 50.0% and 34.5% HFNC use rate. There were no significant baseline differences between patients when comparing hospitals, years and HFNC requirement. HFNC duration was: 94 hs (62-140), 94 hs (63-140) and 83 hs (51-131) for each year (p=0.078, for last comparison). Length of stay wasn’t different between years. HFNC failure was observed in 8.7%, 5.7% and 7.3%, respectively. Over pooled data, respiratory rate at first hour from HFNC initiation was higher in the failure group: 60/min (50-65) vs. 50/min (44-60), p=0.002. No complications were reported. Overall mortality was 0%.Conclusions: The implementation of protocol-driven HNFC therapy in general wards revealed as a safe tool. A lack of reduction in respiratory rate was associated with treatment failure.