Indications and Safety of High Flow Nasal Cannula in Pediatric Intensive Care Unit: Retrospective Single Center Experience in Saudi Arabia

Abstract

Background: High flow nasal cannula (HFNC) is a new device for respiratory support. Its use continues to increase in pediatrics as its system is easily set up and well tolerated by patients. We aimed in this study to explore indications and safety of HFNC use and predictors of HFNC failure. Methods: Hospital records of 92 children with acute respiratory distress admitted to the pediatric intensive care unit (PICU) in Abha Maternity and Children Hospital from January 2018 until March 2020 and received HFNC therapy were studied. A data collection sheet was used that included patients' age, gender, the indication of HFNC, associated chronic diseases, previous admission to PICU, vital signs (initially, 8 hours and 48 hours after using HFNC), outcome after using HFNC, and reasons for HFNC failure. Results: After receiving HFNC, children's respiratory rate, heart rate, systolic blood pressure, and oxygen saturation improved significantly (p < 0.001, p < 0.001, p < 0.001, p = 0.005, and p < 0.001, respectively). Regarding laboratory findings, pH and serum bicarbonate improved significantly (p < 0.001 for both), while PaCO2 improved but not significantly. The failure rate of HFNC was 23.0%. HFNC failure rates were significantly higher among children with chronic diseases than those with no chronic disease (33.3% and 14.9%, respectively, p = 0.038) and among children with the air-leak syndrome (p < 0.001). After 48 hours of HFNC use, children who experienced HFNC failure had significantly higher respiratory and heart rates (p < 0.001 and p = 0.018, respectively), lower diastolic blood pressure (p = 0.011), and higher PaCO2 (p < 0.001). Conclusion:After HFNC use, significant improvements occur in all clinical parameters and laboratory values of children with respiratory distress, but about one-fourth of cases may experience HFNC failure. Predictors for HFNC failure include underlying chronic disease, low diastolic blood pressure, high respiratory rate, high heart rate, high initial PaCO2.

High Flow Nasal Cannula in Pediatric Intensive Care Unit: Still an Open Question [Letter]

“…The failure of HFNC was found in one fourth of the patients participated in the study. 1 However, we believe certain aspects of this study need to be addressed.…”

“…We have read with great interest the article published by Asseri et al which explores the indications and safety of high flow nasal cannula (HFNC) use in Pediatric Intensive Care Unit (PICU) and determine the predictors of its failure in Saudi Arabia. 1 The study identified positive clinical characteristics and laboratory tests in most of the children after 8 hour of the use of HFNC in pediatric patients and the main indications used were respiratory distress secondary to bronchopneumonia, bronchiolitis, status asthmaticus, and post-extubation. The failure of HFNC was found in one fourth of the patients participated in the study.…”

“…We have read with great interest the article published by Asseri et al which explores the indications and safety of high flow nasal cannula (HFNC) use in Pediatric Intensive Care Unit (PICU) and determine the predictors of its failure in Saudi Arabia. 1 …”

The correlation between lung ultrasound scores and outcomes of high-flow nasal cannula therapy in infants with severe pneumonia

“…Most infants with severe pneumonia experience hypoxemia and dyspnea, necessitating effective mechanical respiratory support. A substantial body of research indicates that high-flow nasal cannula (HFNC) therapy can reduce intubation and mortality rates in infants and children with an oxygenation index (PaO 2 /FiO 2 ratio, P/F ratio) below 200 mmHg [ 1 , 2 ]. Recently, HFNC therapy has gained increasing prominence in pediatric intensive care units (PICUs), demonstrating effectiveness in improving oxygenation and reducing the need for tracheal intubation in infant and pediatric patients.…”

“…However, HFNC therapy is not without its failures. Factors predictive of HFNC therapy failure include underlying chronic disease, low diastolic blood pressure, high respiratory and heart rates, and elevated initial PaCO 2 levels [ 2 ].…”