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Published on: December 5, 2025

Clinical Predictors of High-Flow Nasal Cannula Failure in Children with Acute Respiratory Illness: A Single-Center

J Shashank1, Vinod H Ratageri2, Rajeshwari Pawar1

  • 1Department of Pediatrics, Karnataka Medical College and Research Institute, Hubballi, 580021, India.

Indian Journal of Pediatrics
|August 22, 2026
PubMed

Insights

High-flow nasal cannula (HFNC) therapy can fail in children with respiratory distress. Key predictors of failure include a high Respiratory Severity Score (RSS) and low oxygen saturation (SpO2), aiding early intervention.

Area of Science:

  • Pediatric Critical Care
  • Respiratory Medicine

Background:

  • High-flow nasal cannula (HFNC) therapy is widely used for pediatric respiratory distress.
  • Identifying children at risk of HFNC treatment failure is crucial for timely intervention.

Purpose of the Study:

  • To evaluate clinical predictors of HFNC failure in pediatric patients.
  • To identify early warning signs for potential treatment failure.

Main Methods:

  • Retrospective observational study of 50 children (1 mo to 12 y) with moderate-to-severe respiratory illness.
  • Analysis of clinical data including Respiratory Severity Score (RSS) and oxygen saturation (SpO2).

Main Results:

  • HFNC failure occurred in 12% of patients, with two deaths.
  • Significant predictors of failure included RSS ≥10, SpO2 <85%, congenital heart disease, severe acute malnutrition, and anemia.
  • The combination of RSS ≥10 and SpO2 <85% showed the highest predictive accuracy.

Conclusions:

  • Early bedside assessment using RSS and SpO2 can help identify children at risk of HFNC failure.
  • These findings may improve clinical decision-making and facilitate timely escalation of respiratory support, especially in resource-limited settings.

Keywords:
High-flow nasal cannulaPediatricsRespiratory distressRespiratory severity scoreSpO2Treatment failure

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