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J Pediatr Intensive Care 2023; 12(01): 071-078
DOI: 10.1055/s-0041-1730915
Original Article

Clinical Factors of High-Flow Nasal Cannula Oxygen Success in Children

Gokce Iplik
1   Division of Pediatric Intensive Care Unit, Çukurova University Faculty of Medicine, Sarıçam, Adana, Turkey
,
Dincer Yildizdas 
1   Division of Pediatric Intensive Care Unit, Çukurova University Faculty of Medicine, Sarıçam, Adana, Turkey
,
Ahmet Yontem 
1   Division of Pediatric Intensive Care Unit, Çukurova University Faculty of Medicine, Sarıçam, Adana, Turkey
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Abstract

This study was aimed to evaluate the success rate of high-flow nasal cannula (HFNC) oxygen therapy and factors causing therapy failure. This prospective observational study included 131 children who received HFNC oxygen and followed-up in the pediatric emergency department, pediatric clinics, and pediatric intensive care unit between March 2018 and December 2019. The median age was 23.0 months (interquartile range [IQR]: 9.0–92.0) and 65 patients were male (49.6%). The most common reason for requiring HFNC oxygen therapy was pneumonia (n = 75, 57.3%). A complex chronic condition was present in 112 (85.5%) patients. Therapy success was achieved in 116 patients (88.5%). The reason for requiring treatment and the patients' complex chronic condition did not affect the success of the therapy (p = 0.294 and 0.091, respectively). In the first 24 hours of treatment, a significant improvement in pulse rate, respiratory rate, pH, and lactate level were observed in successful HFNC oxygen patients (p < 0.05). In addition, these patients showed a significant improvement in SpO2 and SpO2/FiO2 ratio, and a significant decrease in FiO2 and flow rate (p < 0.05). HFNC oxygen success rate was 95.6% in patients with SpO2/FiO2 ≥ 150 at the 24th hour; it was 58.0% in those with SpO2/FiO2 < 150 (p < 0.001). Caution should be exercised in terms of HFNC oxygen failure in patients with no significant improvement in vital signs and with SpO2/FiO2 < 150 during treatment.

Keywords

children - high-flow nasal cannula oxygen - outcome - respiratory distress


Publication History

Received: 28 December 2020

Accepted: 08 April 2021

Article published online:
15 June 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Lee JH, Rehder KJ, Williford L, Cheifetz IM, Turner DA. Use of high flow nasal cannula in critically ill infants, children, and adults: a critical review of the literature. Intensive Care Med 2013; 39 (02) 247-257
    CrossrefPubMedGoogle Scholar
  • 2 Rubin S, Ghuman A, Deakers T, Khemani R, Ross P, Newth CJ. Effort of breathing in children receiving high-flow nasal cannula. Pediatr Crit Care Med 2014; 15 (01) 1-6
    CrossrefPubMedGoogle Scholar
  • 3 Luo J, Duke T, Chisti MJ, Kepreotes E, Kalinowski V, Li J. Efficacy of high-flow nasal cannula vs standard oxygen therapy or nasal continuous positive airway pressure in children with respiratory distress: a meta-analysis. J Pediatr 2019; 215: 199-208
    CrossrefPubMedGoogle Scholar
  • 4 Kawaguchi A, Garros D, Joffe A. et al. Variation in practice related to the use of high flow nasal cannula in critically ill children. Pediatr Crit Care Med 2020; 21 (05) e228-e235
    CrossrefPubMedGoogle Scholar
  • 5 Kneyber MCJ, de Luca D, Calderini E. et al; Section Respiratory Failure of the European Society for Paediatric and Neonatal Intensive Care. Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC). Intensive Care Med 2017; 43 (12) 1764-1780
    CrossrefPubMedGoogle Scholar
  • 6 Kwon JW. High-flow nasal cannula oxygen therapy in children: a clinical review. Clin Exp Pediatr 2020; 63 (01) 3-7
    CrossrefPubMedGoogle Scholar
  • 7 Feudtner C, Feinstein JA, Zhong W, Hall M, Dai D. Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation. BMC Pediatr 2014; 14: 199
    CrossrefPubMedGoogle Scholar
  • 8 Beggs S, Wong ZH, Kaul S, Ogden KJ, Walters JAE. High-flow nasal cannula therapy for infants with bronchiolitis. Cochrane Database of Syst Rev 2014; 20 (01) CD009609
    PubMedGoogle Scholar
  • 9 Guillot C, Le Reun C, Behal H. et al. First-line treatment using high-flow nasal cannula for children with severe bronchiolitis: Applicability and risk factors for failure. Arch Pediatr 2018; 25 (03) 213-218
    CrossrefPubMedGoogle Scholar
  • 10 Moreel L, Proesmans M. High flow nasal cannula as respiratory support in treating infant bronchiolitis: a systematic review. Eur J Pediatr 2020; 179 (05) 711-718
    CrossrefPubMedGoogle Scholar
  • 11 Richter RP, Alten JA, King RW. et al. Positive airway pressure versus high-flow nasal cannula for prevention of extubation failure in infants after congenital heart surgery. Pediatr Crit Care Med 2019; 20 (02) 149-157
    CrossrefPubMedGoogle Scholar
  • 12 Colleti Jr. J, de Azevedo R, Araujo O, de Carvalho WB. High-flow nasal cannula as a post-extubation respiratory support strategy in preterm infants: a systematic review and meta-analysis. J Pediatr (Rio J) 2020; 96 (04) 422-431
    CrossrefPubMedGoogle Scholar
  • 13 Marjanovic N, Flacher A, Drouet L. et al. High-flow nasal cannula in early emergency department management of acute hypercapnic respiratory failure due to cardiogenic pulmonary edema. Respir Care 2020; 65 (09) 1241-1249
    CrossrefPubMedGoogle Scholar
  • 14 Ballestero Y, De Pedro J, Portillo N, Martinez-Mugica O, Arana-Arri E, Benito J. Pilot clinical trial of high-flow oxygen therapy in children with asthma in the emergency service. J Pediatr 2018; 194: 204-210.e3
    CrossrefPubMedGoogle Scholar
  • 15 Betters KA, Gillespie SE, Miller J, Kotzbauer D, Hebbar KB. High flow nasal cannula use outside of the ICU; factors associated with failure. Pediatr Pulmonol 2017; 52 (06) 806-812
    CrossrefPubMedGoogle Scholar
  • 16 Hutchings FA, Hilliard TN, Davis PJ. Heated humidified high-flow nasal cannula therapy in children. Arch Dis Child 2015; 100 (06) 571-575
    CrossrefPubMedGoogle Scholar
  • 17 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 (12) 1121-1131
    CrossrefPubMedGoogle Scholar
  • 18 Ramnarayan P, Lister P, Dominguez T. et al; United Kingdom Paediatric Intensive Care Society Study Group (PICS-SG). FIRST-line support for Assistance in Breathing in Children (FIRST-ABC): a multicentre pilot randomised controlled trial of high-flow nasal cannula therapy versus continuous positive airway pressure in paediatric critical care. Crit Care 2018; 22 (01) 144
    CrossrefPubMedGoogle Scholar
  • 19 Bressan S, Balzani M, Krauss B, Pettenazzo A, Zanconato S, Baraldi E. High-flow nasal cannula oxygen for bronchiolitis in a pediatric ward: a pilot study. Eur J Pediatr 2013; 172 (12) 1649-1656
    CrossrefPubMedGoogle Scholar
  • 20 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 (10072): 930-939
    CrossrefPubMedGoogle Scholar
  • 21 Vásquez-Hoyos P, Jiménez-Chaves A, Tovar-Velásquez M. et al. Factors associated to high-flow nasal cannula treatment failure in pediatric patients with respiratory failure in two pediatric intensive care units at high altitude. Med Intensiva 2021; 45 (04) 195-204
    PubMedGoogle Scholar
  • 22 Morris JV, Kapetanstrataki M, Parslow RC, Davis PJ, Ramnarayan P. Patterns of use of heated humidified high-flow nasal cannula therapy in PICUs in the United Kingdom and Republic of Ireland. Pediatr Crit Care Med 2019; 20 (03) 223-232
    CrossrefPubMedGoogle Scholar
  • 23 Khemani RG, Smith LS, Zimmerman JJ, Erickson S. Pediatric Acute Lung Injury Consensus Conference Group. Pediatric acute respiratory distress syndrome: definition, incidence, and epidemiology: proceedings from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med 2015; 16 (05, Suppl 1): S23-S40
    CrossrefPubMedGoogle Scholar
  • 24 Lodeserto FJ, Lettich TM, Rezaie SR. High-flow nasal cannula: mechanisms of action and adult and pediatric indications. Cureus 2018; 10 (11) e3639
    PubMedGoogle Scholar
  • 25 Chisti MJ, Salam MA, Smith JH. et al. Bubble continuous positive airway pressure for children with severe pneumonia and hypoxaemia in Bangladesh: an open, randomised controlled trial. Lancet 2015; 386 (9998): 1057-1065
    CrossrefPubMedGoogle Scholar