Utilization of High-Flow Nasal Cannulas in Pediatric Critical Care: A Single-Center Experience

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BACKGROUND: High-flow nasal cannula (HFNC) therapy has developed as a valuable tool for respiratory support in pediatric critical care. It offers an intermediate level of support between traditional low-flow oxygen and non-invasive ventilation (NIV). Studies suggest its effectiveness in improving oxygen delivery, work of breathing, and secretion clearance. METHOD: This retrospective study reviewed medical records of 265 pediatric patients aged between one day to 14 years admitted to the pediatric intensive care unit (PICU) for respiratory distress between 2014 and 2019, who required HFNC therapy. Analyzed data on demographics, diagnoses, HFNC settings, physiologic parameters, complications, and outcomes (e.g., escalation of support, length of stay) using IBM SPSS Statistics software, version 23 (IBM Corp., Armonk, NY). RESULTS: Age, indication, and positive viral nasopharyngeal swabs (NPA) didn't influence the outcome of HFNC. The most common primary admission diagnosis was pneumonia (38.5%); other indications for HFNC treatment included septic shock, pleural effusion, and upper airway obstruction. However, low durations of HFNC, elevated carbon dioxide (CO2), no improvement in potential of hydrogen (pH) after initiation of therapy, and elevated respiratory rate were observed more in the failure group. CONCLUSION: High-flow nasal cannula therapy emerges as a valuable alternative to invasive ventilation in PICU patients. Blood gases, respiratory rate, and heart rate (HR) are important parameters, besides clinical examination, to closely monitor the children susceptible to failure.

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