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Clinical Factors of High-Flow Nasal Cannula Oxygen Success in Children
Gokce Iplik1, Dincer Yildizdas1, Ahmet Yontem1
1Division of Pediatric Intensive Care Unit, Çukurova University Faculty of Medicine, Sarıçam, Adana, Turkey.
Insights
High-flow nasal cannula (HFNC) oxygen therapy is effective for pediatric respiratory distress, with an 88.5% success rate. Early improvements in vital signs and SpO2/FiO2 ratio predict successful HFNC oxygen treatment outcomes.
Area of Science:
- Pediatric Pulmonology
- Critical Care Medicine
- Respiratory Therapy
Background:
- High-flow nasal cannula (HFNC) oxygen therapy is increasingly used in pediatric respiratory distress.
- Understanding HFNC success rates and failure predictors is crucial for optimizing patient care.
Purpose of the Study:
- To evaluate the success rate of HFNC oxygen therapy in children.
- To identify factors associated with HFNC therapy failure.
Main Methods:
- Prospective observational study of 131 children receiving HFNC oxygen.
- Data collected on patient demographics, reasons for therapy, and clinical outcomes.
- Analysis of vital signs, blood gas parameters, and oxygenation indices (SpO2/FiO2 ratio).
Main Results:
- Overall HFNC success rate was 88.5%.
- Significant improvements in pulse rate, respiratory rate, pH, and lactate were observed in successful cases within 24 hours.
- A SpO2/FiO2 ratio < 150 at 24 hours was associated with a lower success rate (58.0%) compared to ≥ 150 (95.6%).
Conclusions:
- HFNC oxygen therapy demonstrates a high success rate in pediatric patients.
- Early improvement in vital signs and oxygenation indices are key indicators of successful HFNC therapy.
- Close monitoring and caution are advised for patients with persistent low SpO2/FiO2 ratios or lack of vital sign improvement.
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 SpO 2 and SpO 2 /FiO 2 ratio, and a significant decrease in FiO 2 and flow rate ( p < 0.05). HFNC oxygen success rate was 95.6% in patients with SpO 2 /FiO 2 ≥ 150 at the 24th hour; it was 58.0% in those with SpO 2 /FiO 2 < 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 SpO 2 /FiO 2 < 150 during treatment.
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