Indications and Safety of High Flow Nasal Cannula in Pediatric Intensive Care Unit: Retrospective Single Center Experience in Saudi Arabia

• Main Authors: Asseri AA, AlQahtani YA, Alhanshani AA, Ali GH, Alhelali I
• Format: Article
• Language: English
• Published: Dove Medical Press 2021-08-01
• Series: Pediatric Health, Medicine and Therapeutics
• Subjects: high flow nasal cannula; respiratory distress; pediatric intensive care; saudi arabia
• Online Access: https://www.dovepress.com/indications-and-safety-of-high-flow-nasal-cannula-in-pediatric-intensi-peer-reviewed-fulltext-article-PHMT

Ali Alsuheel Asseri,1 Youssef Ali AlQahtani,1 Ahmad Ali Alhanshani,1 Ghada Haider Ali,2 Ibrahim Alhelali2 1Department of Child Health, College of Medicine, King Khalid University, Abha, Saudi Arabia; 2Department of Pediatrics, Abha Maternity and Children Hospital, Abha, Saudi ArabiaCorrespondence: Ali Alsuheel AsseriDepartment of Child Health, College of Medicine, King Khalid University, Abha, Saudi ArabiaTel [phone]; [phone]Email [e-mail]: High flow nasal cannula (HFNC) is a new device for respiratory support. Its use continues to increase in pediatrics as its system is easily set up and well tolerated by patients. We aimed in this study to explore indications and safety of HFNC use and predictors of HFNC failure.Methods: Hospital records of 92 children with acute respiratory distress admitted to the pediatric intensive care unit (PICU) in Abha Maternity and Children Hospital from January 2018 until March 2020 and received HFNC therapy were studied. A data collection sheet was used that included patients’ age, gender, the indication of HFNC, associated chronic diseases, previous admission to PICU, vital signs (initially, 8 hours and 48 hours after using HFNC), outcome after using HFNC, and reasons for HFNC failure.Results: After receiving HFNC, children’s respiratory rate, heart rate, systolic blood pressure, and oxygen saturation improved significantly (p < 0.001, p < 0.001, p < 0.001, p = 0.005, and p < 0.001, respectively). Regarding laboratory findings, pH and serum bicarbonate improved significantly (p < 0.001 for both), while PaCO2 improved but not significantly. The failure rate of HFNC was 23.0%. HFNC failure rates were significantly higher among children with chronic diseases than those with no chronic disease (33.3% and 14.9%, respectively, p = 0.038) and among children with the air-leak syndrome (p < 0.001). After 48 hours of HFNC use, children who experienced HFNC failure had significantly higher respiratory and heart rates (p < 0.001 and p = 0.018, respectively), lower diastolic blood pressure (p = 0.011), and higher PaCO2 (p < 0.001).Conclusion: After HFNC use, significant improvements occur in all clinical parameters and laboratory values of children with respiratory distress, but about one-fourth of cases may experience HFNC failure. Predictors for HFNC failure include underlying chronic disease, low diastolic blood pressure, high respiratory rate, high heart rate, high initial PaCO2.Keywords: high flow nasal cannula, respiratory distress, pediatric intensive care, Saudi Arabia