Departments of Pediatric Emergency, University of Health Sciences, Tepecik Training and Research Hospital İzmir, Turkey.
Department of Pediatric Emergency, Demokrasi University Faculty of Medicine, İzmir, Turkey.
Turk J Pediatr. 2022;64(4):648-657. doi: 10.24953/turkjped.2020.587.
High-flow nasal cannula (HFNC) therapy is a relatively new method used in patients with respiratory distress. The aim of the study was to evaluate the outcomes and to determine the baseline predictors of HFNC treatment failure in children with acute respiratory distress/failure in the pediatric emergency department.
Children with respiratory distress/failure aged 1 month to 18 years who underwent HFNC therapy with the pre-established protocol were retrospectively analyzed. HFNC therapy was used in respiratory and non-respiratory pathologies. HFNC failure was defined as the need for escalation to non-invasive ventilation or invasive mechanical ventilation. HFNC responders and non-responders were compared based on baseline clinical data.
Of the 524 cases (median age:13 months; 292 males / 232 females), 484 (92.4%) had respiratory tract and 40 (7.6%) had non-respiratory tract pathologies. HFNC therapy was unsuccessful in 62 (11.8%) patients. The success rates were 81% and 55% in respiratory and non-respiratory diseases, respectively. In children with respiratory system pathologies, the pre-treatment venous pCO2 level (p: 0.045; OR: 0.958; 95%CI: 0.821-0.990) and the clinically important radiological finding on chest X-ray (lobar infiltration, atelectasis, pleural effusion) (p: 0.045; OR: 3.262; 95%CI: 1.178-9.034) were the most significant parameters in predicting HFNC failure. In children with non-respiratory pathologies, the pre-treatment venous lactate level (p: 0.008; OR: 1.558; 95%CI: 1.125-2.158) was a significant predictor of HFNC failure. There were no cases of pneumothorax or any other reported adverse effects related to HFNC therapy.
HFNC treatment is a safe oxygen therapy in children with respiratory distress/failure due to various etiologies in the emergency department. The lower venous pCO2 level increases and the clinically important radiological finding on chest radiograph decreases the success of HFNC treatment in respiratory pathologies. The higher venous lactate level is a predictor of HFNC treatment failure in non-respiratory pathologies.
高流量鼻导管（HFNC）治疗是一种用于治疗呼吸窘迫患者的相对较新的方法。本研究旨在评估 HFNC 治疗在儿科急诊呼吸窘迫/衰竭儿童中的结果，并确定 HFNC 治疗失败的基线预测因素。
回顾性分析了 524 例（中位年龄 13 个月；292 例男性/232 例女性）接受 HFNC 治疗的呼吸窘迫/衰竭患儿。HFNC 治疗用于呼吸道和非呼吸道疾病。HFNC 治疗失败定义为需要升级为无创通气或有创机械通气。根据基线临床数据比较 HFNC 应答者和无应答者。
在 524 例患儿中（中位年龄 13 个月；292 例男性/232 例女性），484 例（92.4%）存在呼吸道疾病，40 例（7.6%）存在非呼吸道疾病。62 例（11.8%）患儿 HFNC 治疗无效。呼吸道疾病患儿的成功率为 81%，非呼吸道疾病患儿的成功率为 55%。在有呼吸系统疾病的儿童中，治疗前静脉 pCO2 水平（p：0.045；OR：0.958；95%CI：0.821-0.990）和胸部 X 线检查中具有临床重要意义的影像学发现（肺叶浸润、肺不张、胸腔积液）（p：0.045；OR：3.262；95%CI：1.178-9.034）是预测 HFNC 治疗失败的最显著参数。在非呼吸道疾病患儿中，治疗前静脉血乳酸水平（p：0.008；OR：1.558；95%CI：1.125-2.158）是 HFNC 治疗失败的显著预测因素。没有气胸或与 HFNC 治疗相关的其他不良事件报告。
HFNC 治疗是一种安全的氧疗方法，可用于急诊科各种病因引起的呼吸窘迫/衰竭的儿童。较低的静脉 pCO2 水平升高和胸部 X 线具有临床重要意义的影像学发现减少了 HFNC 治疗在呼吸道疾病中的成功率。较高的静脉血乳酸水平是预测非呼吸道疾病 HFNC 治疗失败的指标。
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