Sitthikarnkha Phanthila, Uppala Rattapon, Thiraratananukulchai Apichaya, Sirikarn Prapassara, Techasatian Leelawadee, Saengnipanthkul Suchaorn, Niamsanit Sirapoom
Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand.
PLoS One. 2025 Jul 14;20(7):e0328442. doi: 10.1371/journal.pone.0328442. eCollection 2025.
Lower respiratory tract infection (LRTI) is a leading cause of childhood hospitalization worldwide, with high-flow nasal cannula (HFNC) therapy commonly employed as a non-invasive respiratory support method. Determining early predictors of HFNC failure is crucial for timely intervention and reducing associated morbidity and mortality.
We retrospectively reviewed the medical records of hospitalized children aged 1 month to 18 years with LRTI who received HFNC from January 2016 to December 2021. We aimed to evaluate predictive factors for HFNC failure and identify optimal cutoffs from the AUROC (AUROC).
One hundred and sixteen children with LRTI applied to HFNC were included in this study. Most of them (90.5%) were diagnosed with pneumonia as a principal diagnosis, and 68.9% had co-morbidities. Of those, 18 patients (15.5%) needed escalation to intubation and were defined as HFNC failure. The early predictive parameters associated with HFNC failure were pulse rate at 2 hours and SpO2/FiO2 ratio at 4 hours. AUROC analysis for the predictive parameter of HFNC failure showed cut-off values of S/F ratio at 4 hours after HFNC therapy was lower than 238 (AUC 0.89, 95%CI: 0.78-0.99).
SpO2/FiO2 at 4 hours after initiating HFNC appeared to be a predicting value for early detected failure for HFNC therapy in children with LRTI. Close monitoring and swift management adjustments are recommended for children exhibiting these risk factors to enhance outcomes.
下呼吸道感染（LRTI）是全球儿童住院治疗的主要原因，高流量鼻导管（HFNC）疗法通常作为一种无创呼吸支持方法使用。确定HFNC失败的早期预测因素对于及时干预和降低相关发病率及死亡率至关重要。
我们回顾性分析了2016年1月至2021年12月期间因LRTI接受HFNC治疗的1个月至18岁住院儿童的病历。我们旨在评估HFNC失败的预测因素，并从曲线下面积（AUROC）中确定最佳截断值。
本研究纳入了116例接受HFNC治疗的LRTI儿童。其中大多数（90.5%）被诊断为肺炎作为主要诊断，68.9%患有合并症。其中，18例患者（15.5%）需要升级为插管，并被定义为HFNC失败。与HFNC失败相关的早期预测参数为2小时时的脉搏率和4小时时的SpO2/FiO2比值。HFNC失败预测参数的AUROC分析显示，HFNC治疗后4小时的S/F比值截断值低于238（AUC 0.89，95%CI：0.78 - 0.99）。
开始HFNC治疗后4小时的SpO2/FiO2似乎是LRTI儿童HFNC治疗早期失败的预测值。对于表现出这些危险因素的儿童，建议密切监测并迅速调整管理措施以改善预后。
