Use of high-flow cannula in pediatric patients with respiratory failure: A prospective cohort study in three high-altitude hospitals
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Natalia Ante-Ardila1, Camilo Novoa Garnica1, Paola Mora Umaña1
1Department of Pediatrics Universidad de los Andes Bogotá Colombia.
Insights
High-flow nasal cannula (HFNC) is frequently used for acute respiratory failure (ARF) in children, particularly for bronchiolitis. The study found a low failure rate of 10.6% for HFNC in pediatric intensive care units.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Medicine
- Medical Devices
Background:
- Acute respiratory failure (ARF) is a significant cause of mortality and a common reason for pediatric intensive care unit (PICU) admission.
- High-flow nasal cannula (HFNC) is a key treatment for ARF, necessitating an understanding of its usage patterns and effectiveness.
Purpose of the Study:
- To determine the frequency of HFNC use in pediatric ARF.
- To identify the primary indications for HFNC therapy.
- To assess the prevalence and causes of HFNC failure in a multicenter setting.
Main Methods:
- A prospective cohort study was conducted across three hospitals in Bogota.
- Included were pediatric patients (1 month to 18 years) with ARF requiring HFNC.
- Data collection occurred between April 2020 and December 2021, with follow-up at 1, 6, and 48 hours.
Main Results:
- Of 685 patients, 296 (48%) had ARF requiring HFNC.
- Bronchiolitis was the most common indication (34.5%), followed by asthmatic crisis (15.5%) and pneumonia (12.7%).
- The overall HFNC failure rate was 10.6%, with 15 patients requiring invasive mechanical ventilation.
Conclusions:
- HFNC is frequently used in pediatric ARF, especially for bronchiolitis in young males.
- The low failure rate (10.6%) suggests HFNC is effective and can be considered for various pediatric respiratory conditions.
- Further research is warranted to explore the role of HFNC in pediatric respiratory pathologies.
Background And Aims:
Acute respiratory failure (ARF) is a common cause of morbimortality, and a frequent reason for admission to the pediatric intensive care unit (PICU). It requires a high-flow oxygen device as treatment. Our aim is to determine the frequency and main indications for the use of high-flow nasal cannula (HFNC), and the prevalence of HFNC failure and its main causes, in three hospitals.
Methods:
It is a multicenter prospective cohort study, developed in three hospitals in Bogota. Eligible patients were children older than 1 month and younger than 18 years who presented ARF and required management with an HFNC. The study was carried out between April 2020 and December 2021. The follow-up was carried out at 1, 6, and 48 h after starting the management.
Results:
Of 685 patients included in the study, 296 developed ARF. The prevalence of patients with ARF who required management with HFNC was 48%. The frequency of the pathologies that cause the ARF was: Bronchiolitis was the most frequent pathology (34.5%), followed by asthmatic crisis (15.5%) and pneumonia (12.7%). The average time of use of HFNC was 81.6 h. Regarding treatment failure with HFNC, 15 patients presented torpid evolution and required invasive mechanical ventilation, with a prevalence of therapeutic failure of the HFNC of 10.6%.
Conclusion:
The use of HFNC is more frequent in patients with bronchiolitis, in children under 2 years of age and in males, which is in line with what has been reported in the literature. In addition, the failure rate of HFNC is low (10.6%), and it may be useful in other pathologies besides bronchiolitis, such as asthma, pneumonia, among others. It opens the possibility to continue evaluating the role of HFNC in pediatric pathology in new studies.
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