Wu Jeng-Hung, Wang Ching-Chia, Lu Frank Leigh, Huang Shu-Chien, Wu En-Ting
Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Medicine, National Taiwan University Hospital Jinshan Branch, New Taipei City, Taiwan.
Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
J Formos Med Assoc. 2025 Jan;124(1):15-21. doi: 10.1016/j.jfma.2024.05.008. Epub 2024 May 15.
BACKGROUND/PURPOSE: The use of high-flow nasal cannulas (HFNC) in patients admitted to the pediatric intensive care unit (PICU) has gradually increased worldwide; however, details on clinical efficacy remain limited in Taiwan. Therefore, we explored the clinical characteristics and outcomes of pediatric patients using HFNC in the PICU.
Medical records were retrospectively collected from pediatric patients (aged <18 years) who received HFNC support from December 2021 to January 2023 in the PICU of a medical center. Outcome parameters included treatment failure (defined as increased respiratory support to advanced non-invasive ventilators or intubations), duration of support from HFNC, and changes in clinical parameters after initiating HFNC.
A total of 261 episodes of HFNC use were included, with a failure rate of 24.5% and a median support length of 4 days. Multivariable analysis showed that infant age (adjusted odds ratio [aOR]: 2.1, p = 0.02) and accompanying complex chronic disease (aOR: 4.4, p = 0.014) were risk factors for treatment failure and a diagnosis of asthma or bronchiolitis had a lower hazard of treatment failure (aOR: 0.29, p = 0.025) than other diagnoses did. Improvements in clinical parameters, including pulse rate, respiratory rate, SpO, and CO levels, were observed 24 h after the initiation of HFNC.
The application of HFNC in the PICU in Taiwan is effective but should be performed with care in infants with accompanying complex chronic diseases. In addition to low treatment failure, HFNC utilizations stabilized the clinical parameters of children with asthma/bronchiolitis within one day.
背景/目的：在全球范围内，儿科重症监护病房（PICU）收治的患者中，高流量鼻导管（HFNC）的使用逐渐增多；然而，在台湾，关于其临床疗效的详细信息仍然有限。因此，我们探讨了PICU中使用HFNC的儿科患者的临床特征和预后。
回顾性收集2021年12月至2023年1月在某医疗中心PICU接受HFNC支持的儿科患者（年龄<18岁）的病历。结局参数包括治疗失败（定义为增加呼吸支持至高级无创通气或插管）、HFNC支持持续时间以及开始使用HFNC后临床参数的变化。
共纳入261例HFNC使用病例，失败率为24.5%，中位支持时长为4天。多变量分析显示，婴儿年龄（调整后的优势比[aOR]：2.1，p = 0.02）和伴有复杂慢性病（aOR：4.4，p = 0.014）是治疗失败的危险因素，哮喘或细支气管炎诊断的治疗失败风险低于其他诊断（aOR：0.29，p = 0.025）。开始使用HFNC后24小时观察到临床参数改善，包括心率、呼吸频率、SpO和CO水平。
台湾PICU中HFNC的应用是有效的，但对于伴有复杂慢性病的婴儿应谨慎使用。除治疗失败率低外，HFNC的使用在一天内稳定了哮喘/细支气管炎患儿的临床参数。
