Factors associated with heated humidified high-flow nasal cannula failure in children at 50th Anniversary Mahavajiralongkorn Hospital
Keywords:
HHFNC, Pediatric patients, Failure, S/F ratio, ROX indexAbstract
Background: Respiratory distress is common in pediatric patients. Heated humidified high flow nasal cannula (HHFNC) use has increased at present. Identification of factors associated with treatment failure enables closer monitoring and better treatment outcomes.
Objectives: To determine the rate of HHFNC failure and its associated factors among pediatric patients at 50th Anniversary Mahavajiralongkorn Hospital.
Methods: This was a retrospective study reviewing medical records for pediatric patients aged 1 month to 15 years who received HHFNC therapy between October 1, 2022, and September 30, 2025. Descriptive statistics were used to summarize patient characteristics and incidence, the correlations between factors with HHFNC failure were constructed by chi-square test and binary logistic regression analysis.
Results: A total of 445 patients were included in the study, the mean age was 36 months, and 61.6% were male. Pneumonia was present in 72.6% of cases, and asthma was the most common comorbidity (14.3%). HHFNC failure occurred in 30 patients (6.7%). At 2 hours, the ROX index was lower in the failure group than in the success group (5.68 ± 2.16 vs. 9.26 ± 32.07, p value 0.001). At 4 hours, the S/F ratio was also lower in the failure group (200.84 ± 84.88 vs. 215.94 ± 80.74, p value 0.017). Factors associated with HHFNC failure included history of prior mechanical ventilation (OR 4.35, 95% CI 1.23-14.29), a respiratory-rate reduction <20% within 2 hours (OR 10.78, 95% CI 1.25-92.96), and maximum FiO2 > 60% (OR 12.50, 95% CI 4.55-33.33).
Conclusion: The HHFNC failure rate was 6.74%, factors associated with failure included prior mechanical ventilation, respiratory rate decreased by < 20% within 2 hours, and maximum FiO2 > 60%. The S/F ratio and ROX index were significantly lower in the failure group at 4 hours and then 2 hours respectively.
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