Factors associated with failure of using high flow nasal cannula in children

Abstract

Abstract Introduction High flow nasal cannula (HFNC) has significantly success in treating acute respiratory distress while HFNC failure dramatically increases mortality and morbidity. Objective To describe factors associated with failure of HFNC use in children. Methods We performed a retrospective observational study using demographic and laboratory findings. We compared clinical and laboratory variables in both successful and failed HFNC groups. The correlations between factors and HFNC failure were constructed by binary logistic regression analysis. Results Between August 2016 and May 2018, 250 children receiving HFNC (median age 16 months; range 1–228 months, male 50.8%) were enrolled. Pneumonia was the most common cause of respiratory distress, and the median length of stay (LOS) in hospital was 11 days. HFNC failure was found 16.4% while HFNC complication was 4.8% including epistaxis, pressure sore, and gastric distension. Based on multivariable logistic regression analysis, factors associated with HFNC failure were children with congenital heart disease comorbidity (p = 0.005), HFNC use with maximum FiO2 > 0.6 (p = 0.021), lobar infiltration on chest X‐ray (p = 0.012), the reduction of heart rate, and respiratory rate 0.6, lobar infiltration on chest X‐ray should be closely monitored. Heart rate and respiratory rate are important parameters in addition to clinical assessment for evaluating HFNC failure in children.

Keywords

• children
• high flow nasal cannula
• non‐invasive ventilation
• respiratory support