Effectiveness of the use of High Flow Nasal Cannula in pediatric patients with respiratory distress in middle-level community hospital

Abstract

Background: Respiratory distress is an emergency that requires immediate diagnosis and treatment. A high-flow nasal Cannula (HFNC) offers a promising alternative as a noninvasive respiratory support. Phayakkhaphum Phisai Hospital started to implement HFNC in the pediatric department in 2018.

Objectives: This study aims to evaluate the effectiveness of HFNC in treating respiratory distress in pediatric patients. The respiratory rates (RR) and oxygen saturation values (SpO₂) were compared before and after HFNC administration to assess its impact on respiratory function.

Methods: This retrospective study investigated data from pediatric patients aged one month to 15 years who were admitted to the hospital between January 1 and December 31, 2023. Patients with dyspnea who were eligible for HFNC treatment were included in chart reviews. A sample of 90 successfully treated patients using HFNC from total 248 successful cases was randomly selected for data extraction from their medical records. This study compared the overall differences in RR and SpO₂ before and after HFNC administration at different time points using the Friedman Test, with a statistical significance level set at 0.05.

Results: The success rate of HFNC was 93.6% (248 out of 265 cases) in 2023. The majority of successful HFNC patients were between 1 and 5 years old. Pneumonia was the most common cause of respiratory distress (47.8%), followed by bronchitis, acute asthmatic attack, croup, and bronchiolitis. The median duration of hospital admission was 5 days, and the median duration of HFNC use was 4 days. Notably, 81.1% of patients received HFNC upon initial admissions to the inpatient ward. The results revealed significant improvements in RR (p ≤ 0.0001) and SpO₂ (p ≤ 0.01) within the first hour of HFNC initiation. Adverse events associated with the use of HFNC were uncommon (6.6%), including abdominal distension and pain (3.3%), dry (2.2%), and bleeding per nose (1.1%). No severe complications were reported.

Conclusion: This study not only demonstrates the effectiveness of HFNC therapy in pediatric patients with respiratory distress but also underscores its safety. HFNC offers a well-tolerated approach with minimal complications. Clinical improvements can be observed within the first hour of treatment, including significant reductions in RR and increases in SpO₂. Early initiation of HFNC may decrease the need for endotracheal intubation. These findings suggest that HFNC is a valuable option for managing pediatric respiratory distress in middle-level community hospitals.