FACTORS DETERMINING THE SUCCESSFUL USE OF HIGH FLOW NASAL CANNULA OXYGEN THERAPY IN AN ASIAN PAEDIATRIC CENTRE
Lijia Fan,Wen Yi Thong
Khoo Teck Puat National University Childrens Medical Institute National University Health System Singapore Khoo Teck Puat National University Childrens Medical Institute, National University Health System, Singapore
Background : High flow nasal cannula (HFNC) oxygen therapy is a widely used form of respiratory support for childen with respiratory distress. This study aims to examine the clinical characteristics of patients requiring HFNC oxygen therapy and assess the differences in their clinical outcomes. This would guide us to identify a group of patients who will more likely benefit from HFNC oxygen therapy.
Material : In this single-centre retrospective cohort study, clinical data was collected from all patients admitted to PICU and HD of an academic tertiary paediatric centre from January 2016 to June 2018, who received HFNC oxygen therapy for moderate to severe respiratory distress. The primary outcome was escalation of respiratory support to non-invasive ventilation or intubation and mechanical ventilation.
Results : A total of 64 patients (age range 1 month to 13 years) were included in the study. HFNC oxygen therapy was used for a range of medical indications including bronchiolitis, pneumonia and respiratory support post-extubation. Bronchiolitis was the most common indication for the use of HFNC oxygen therapy, occurring in 22 patients (34.0%). 18 patients (28.0%) required escalation of respiratory support. Higher initial respiratory rate (RR) and lower capillary blood pH before initiation of HFNC oxygen therapy were associated with failure of treatment, p= 0.041, and 0.003 respectively. The logistic regression model showed that initial RR and blood capillary pH were significant factors associated with escalation of respiratory support (p= 0.010, and p = 0.009 respectively). The area under the receiver operating characteristic curve was 0.81 (95% CI 0.69 - 0.93).
Conclusions : HFNC oxygen therapy is an effective form of respiratory support for paediatric patients with moderate to severe respiratory distress. Appropriate selection of patients, based on their initial clinical parameters and blood gas results, is important in the successful use of HFNC oxygen therapy.
Keywords: High flow nasal cannula oxygen therapy Respiratory distress Bronchiolitis
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