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Nasal high flow therapy introduction lowers reintubation risk in a Peruvian paediatric intensive care unit

Katie R Nielsen1,2, María R Becerra3, Gabriela Mallma3

  • 1Department of Pediatrics, Critical Care Medicine, University of Washington, Seattle, Washington.

Acta Paediatrica (Oslo, Norway : 1992)
|March 22, 2020
PubMed

Insights

High-flow nasal oxygen therapy (HFNT) and CPAP reduced reintubation risk in children post-extubation. While not impacting mechanical ventilation needs, HFNT showed promise in resource-limited settings.

Area of Science:

  • Pediatric Intensive Care
  • Respiratory Medicine
  • Critical Care

Background:

  • Post-extubation respiratory failure is a significant concern in pediatric intensive care units (PICUs).
  • High-flow nasal oxygen therapy (HFNT) is an emerging treatment for respiratory distress.
  • Evaluating HFNT's effectiveness in resource-constrained settings is crucial.

Purpose of the Study:

  • To assess the impact of HFNT on children under five experiencing post-extubation respiratory failure in a Peruvian PICU.
  • To compare clinical outcomes between HFNT, continuous positive airway pressure (CPAP), and historical CPAP controls.

Main Methods:

  • A quasi-experimental study comparing outcomes before and after HFNT implementation.
  • Three groups were analyzed: post-extubation HFNT, post-extubation CPAP, and historical CPAP controls.
  • Primary outcome was the need for mechanical ventilation; survival analysis was used to calculate adjusted hazard ratios.

Main Results:

  • Neither HFNT nor CPAP significantly altered the need for mechanical ventilation post-extubation.
  • Both HFNT and CPAP demonstrated a significant reduction in the risk of reintubation.
  • PICU length of stay was shorter with HFNT (18 days) and CPAP (11 days) compared to historical CPAP (37 days); mortality was 7% (HFNT), 12% (CPAP), and 27% (historical CPAP).

Conclusions:

  • HFNT offers effective respiratory support for pediatric patients in resource-limited environments.
  • Further large-scale studies are warranted to confirm HFNT's benefits in similar settings.
Abstract

Keywords:
critical care outcomesimplementation sciencenon-invasive ventilationreintubationrespiratory failure

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