The applications of high-flow nasal cannulas in pediatric intensive care units in Taiwan

Jeng-Hung Wu; Ching-Chia Wang; Frank Leigh Lu; Shu-Chien Huang; En-Ting Wu

doi:10.1016/j.jfma.2024.05.008

The applications of high-flow nasal cannulas in pediatric intensive care units in Taiwan

J Formos Med Assoc. 2024 May 14:S0929-6646(24)00244-4. doi: 10.1016/j.jfma.2024.05.008. Online ahead of print.

Authors

Jeng-Hung Wu¹, Ching-Chia Wang², Frank Leigh Lu², Shu-Chien Huang³, En-Ting Wu⁴

Affiliations

¹ 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.
² Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
³ Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
⁴ Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan. Electronic address: entingwu@gmail.com.

PMID: 38749900
DOI: 10.1016/j.jfma.2024.05.008

Abstract

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.

Methods: 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.

Results: 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, SpO₂, and CO₂ levels, were observed 24 h after the initiation of HFNC.

Conclusion: 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.

Keywords: Asthma; Bronchiolitis; High-flow nasal cannula; Pediatric intensive care unit; Treatment failure.