Volume 6, Issue 3, September 2020, Page: 182-189
Pediatric High Flow Nasal Cannula Experience in a Tertiary Care Hospital in Saudi Arabia
Alayed Tareq, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
Skaff Chahdah, Dr. Sulaiman Alhabib Medical Group, Riyadh, Saudi Arabia
Alabdulsalam Moath, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
Alturki Abdullah, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
Aljofan Fahad, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
Alanzi Fawaz, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
Alofaisan Tareq, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
Received: Mar. 15, 2020;       Accepted: Mar. 30, 2020;       Published: May 12, 2020
DOI: 10.11648/j.ajp.20200603.13      View  31      Downloads  19
Acute respiratory failure, being a significant problem in Pediatric intensive care units, always requires support, whether via invasive or non-invasive devices. High flow nasal cannula, a relatively new machine, has multiple favorable physiological effects when used for respiratory distressed patients. It is currently widely applied in multiple settings, including PICU. This study describes the experience of HFNC use in a tertiary care hospital in Saudi Arabia. The primary outcome of interest was the intubation rate. The secondary outcomes were mortality rate and length of stay in the pediatric intensive care unit. Moreover, we compared these outcomes between two groups of patients: immunocompromised and immunocompetent patients. Four hundred thirteen patients were included. 45.5% admitted due to pneumonia. 24.6% of patients required intubation with an interval time between the initiation of HFNC and intubation being 40 hours (hrs.). The mortality rate was 17%, and the mean length of stay in PICU was 12 days. One hundred thirty six (35%) patients were immunocompromised. The majority admitted because of pneumonia (70%). There was a significant statistical difference in the rate of intubation (35.5% vs. 25%, P-value 0.03) and mortality (39% vs. 5.5% with a p-value of <0.0001) between the two groups. However, when comparing the mortality rate in the immunocompromised patients only, 81.6% were intubated compared to 14.6% required only HFNC (p < 0.05). HFNC seems to be beneficial and tolerable to pediatric populations. Although the immunocompromised patients showed expected higher mortality and intubation rate compared to the non-immunocompromised, the sub-analysis showed that those who required only HFNC had a better survival rate.
High Flow Nasal Cannula, Pediatric, PICU, Immunocompromised Patient
To cite this article
Alayed Tareq, Skaff Chahdah, Alabdulsalam Moath, Alturki Abdullah, Aljofan Fahad, Alanzi Fawaz, Alofaisan Tareq, Pediatric High Flow Nasal Cannula Experience in a Tertiary Care Hospital in Saudi Arabia, American Journal of Pediatrics. Vol. 6, No. 3, 2020, pp. 182-189. doi: 10.11648/j.ajp.20200603.13
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Mayfield S, Jauncey-Cooke J, Hough JL, Schibler A, Gibbons K, Bogossian F. High-flow nasal cannula therapy for respiratory support in children. Cochrane Database of Systematic Reviews. 2014 (3).
Wilkinson D, Andersen C, O'Donnell CP, De Paoli AG, Manley BJ. High flow nasal cannula for respiratory support in preterm infants. Cochrane Database Syst Rev. 2016; 2: CD006405.
Ramnarayan P, Schibler A. Glass half empty or half full? The story of high-flow nasal cannula therapy in critically ill children. Intensive Care Med. 2017; 43 (2): 246-9.
Milési C, Boubal M, Jacquot A, Baleine J, Durand S, Odena MP, et al. High-flow nasal cannula: recommendations for daily practice in pediatrics. Annals of intensive care. 2014; 4: 29.
Gotera C, Diaz Lobato S, Pinto T, Winck JC. Clinical evidence on high flow oxygen therapy and active humidification in adults. Rev Port Pneumol. 2013; 19 (5): 217-27.
Vargas F, Saint-Leger M, Boyer A, Bui NH, Hilbert G. Physiologic Effects of High-Flow Nasal Cannula Oxygen in Critical Care Subjects. Respir Care. 2015; 60 (10): 1369-76.
Nagata K, Morimoto T, Fujimoto D, Otoshi T, Nakagawa A, Otsuka K, et al. Efficacy of High-Flow Nasal Cannula Therapy in Acute Hypoxemic Respiratory Failure: Decreased Use of Mechanical Ventilation. Respir Care. 2015; 60 (10): 1390-6.
Bermudez Barrezueta L, Garcia Carbonell N, Lopez Montes J, Gomez Zafra R, Marin Reina P, Herrmannova J, et al. [High flow nasal cannula oxygen therapy in the treatment of acute bronchiolitis in neonates]. An Pediatr (Barc). 2017; 86 (1): 37-44.
Schibler A, Pham TM, Dunster KR, Foster K, Barlow A, Gibbons K, et al. Reduced intubation rates for infants after introduction of high-flow nasal prong oxygen delivery. Intensive Care Med. 2011; 37 (5): 847-52.
McKiernan C, Chua LC, Visintainer PF, Allen H. High Flow Nasal Cannulae Therapy in Infants with Bronchiolitis. The Journal of Pediatrics. 2010; 156 (4): 634-8.
Metge P, Grimaldi C, Hassid S, Thomachot L, Loundou A, Martin C, et al. Comparison of a high-flow humidified nasal cannula to nasal continuous positive airway pressure in children with acute bronchiolitis: experience in a pediatric intensive care unit. Eur J Pediatr. 2014; 173 (7): 953-8.
Riese J, Fierce J, Riese A, Alverson BK. Effect of a Hospital-wide High-Flow Nasal Cannula Protocol on Clinical Outcomes and Resource Utilization of Bronchiolitis Patients Admitted to the PICU. Hosp Pediatr. 2015; 5 (12): 613-8.
Milani GP, Plebani AM, Arturi E, Brusa D, Esposito S, Dell'Era L, et al. Using a high-flow nasal cannula provided superior results to low-flow oxygen delivery in moderate to severe bronchiolitis. Acta Paediatr. 2016; 105 (8): e368-72.
ten Brink F, Duke T, Evans J. High-flow nasal prong oxygen therapy or nasopharyngeal continuous positive airway pressure for children with moderate-to-severe respiratory distress?*. Pediatr Crit Care Med. 2013; 14 (7): e326-31.
Hegde S, Prodhan P. Serious air leak syndrome complicating high-flow nasal cannula therapy: a report of 3 cases. Pediatrics. 2013; 131 (3): e939-44.
Sztrymf B, Messika J, Mayot T, Lenglet H, Dreyfuss D, Ricard JD. Impact of high-flow nasal cannula oxygen therapy on intensive care unit patients with acute respiratory failure: a prospective observational study. J Crit Care. 2012; 27 (3): 324 e9-13.
Maggiore SM, Idone FA, Vaschetto R, Festa R, Cataldo A, Antonicelli F, et al. Nasal high-flow versus Venturi mask oxygen therapy after extubation. Effects on oxygenation, comfort, and clinical outcome. Am J Respir Crit Care Med. 2014; 190 (3): 282-8.
Frat JP, Thille AW, Mercat A, Girault C, Ragot S, Perbet S, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med. 2015; 372 (23): 2185-96.
Jones PG, Kamona S, Doran O, Sawtell F, Wilsher M. Randomized Controlled Trial of Humidified High-Flow Nasal Oxygen for Acute Respiratory Distress in the Emergency Department: The HOT-ER Study. Respir Care. 2016; 61 (3): 291-9.
Gaunt KA, Spilman SK, Halub ME, Jackson JA, Lamb KD, Sahr SM. High-Flow Nasal Cannula in a Mixed Adult ICU. Respir Care. 2015; 60 (10): 1383-9.
Collins CL, Holberton JR, Barfield C, Davis PG. A randomized controlled trial to compare heated humidified high-flow nasal cannulae with nasal continuous positive airway pressure postextubation in premature infants. J Pediatr. 2013; 162 (5): 949-54 e1.
Wing R, James C, Maranda LS, Armsby CC. Use of High-Flow Nasal Cannula Support in the Emergency Department Reduces the Need for Intubation in Pediatric Acute Respiratory Insufficiency. Pediatric Emergency Care. 2012; 28 (11): 1117-23.
Testa G, Iodice F, Ricci Z, Vitale V, De Razza F, Haiberger R, et al. Comparative evaluation of high-flow nasal cannula and conventional oxygen therapy in paediatric cardiac surgical patients: a randomized controlled trial. Interact Cardiovasc Thorac Surg. 2014; 19 (3): 456-61.
Mikalsen IB, Davis P, Oymar K. High flow nasal cannula in children: a literature review. Scand J Trauma Resusc Emerg Med. 2016; 24: 93.
Miller AG, Gentle MA, Tyler LM, Napolitano N. High-Flow Nasal Cannula in Pediatric Patients: A Survey of Clinical Practice. Respir Care. 2018; 63 (7): 894-9.
Lee JH, Rehder KJ, Williford L, Cheifetz IM, Turner DA. Use of high flow nasal cannula in critically ill infants, children, and adults: a critical review of the literature. Intensive Care Med. 2013; 39 (2): 247-57.
Milesi C, Pierre AF, Deho A, Pouyau R, Liet JM, Guillot C, et al. A multicenter randomized controlled trial of a 3-L/kg/min versus 2-L/kg/min high-flow nasal cannula flow rate in young infants with severe viral bronchiolitis (TRAMONTANE 2). Intensive Care Med. 2018; 44 (11): 1870-8.
Hough JL, Pham TM, Schibler A. Physiologic effect of high-flow nasal cannula in infants with bronchiolitis. Pediatr Crit Care Med. 2014; 15 (5): e214-9.
Dysart K, Miller TL, Wolfson MR, Shaffer TH. Research in high flow therapy: mechanisms of action. Respir Med. 2009; 103 (10): 1400-5.
Wettstein RB, Shelledy DC, Peters JI. Delivered Oxygen Concentrations Using Low-Flow and High-Flow Nasal Cannulas. Respiratory Care. 2005; 50 (5): 604-9.
Numa AH, Newth CJ. Anatomic dead space in infants and children. J Appl Physiol (1985). 1996; 80 (5): 1485-9.
Parke RL, McGuinness SP. Pressures delivered by nasal high flow oxygen during all phases of the respiratory cycle. Respir Care. 2013; 58 (10): 1621-4.
Milesi C, Baleine J, Matecki S, Durand S, Combes C, Novais AR, et al. Is treatment with a high flow nasal cannula effective in acute viral bronchiolitis? A physiologic study. Intensive Care Med. 2013; 39 (6): 1088-94.
Sivieri EM, Gerdes JS, Abbasi S. Effect of HFNC flow rate, cannula size, and nares diameter on generated airway pressures: an in vitro study. Pediatr Pulmonol. 2013; 48 (5): 506-14.
Hasan RA, Habib RH. Effects of flow rate and airleak at the nares and mouth opening on positive distending pressure delivery using commercially available high-flow nasal cannula systems: a lung model study. Pediatr Crit Care Med. 2011; 12 (1): e29-33.
Chidekel A, Zhu Y, Wang J, Mosko JJ, Rodriguez E, Shaffer TH. The effects of gas humidification with high-flow nasal cannula on cultured human airway epithelial cells. Pulm Med. 2012; 2012: 380686.
Hasani A, Chapman T, McCool D, Smith R, Dilworth J, Agnew J. Domiciliary humidification improves lung mucociliary clearance in patients with bronchiectasis. Chronic Respiratory Disease. 2008; 5 (2): 81-6.
Fontanari P, Burnet H, Zattara-Hartmann MC, Jammes Y. Changes in airway resistance induced by nasal inhalation of cold dry, dry, or moist air in normal individuals. Journal of Applied Physiology. 1996; 81 (4): 1739-43.
Rubin S, Ghuman A, Deakers T, Khemani R, Ross P, Newth CJ. Effort of breathing in children receiving high-flow nasal cannula. Pediatr Crit Care Med. 2014; 15 (1): 1-6.
Richter RP, Alten JA, King RW, Gans AD, Rahman AF, Kalra Y, et al. Positive Airway Pressure Versus High-Flow Nasal Cannula for Prevention of Extubation Failure in Infants After Congenital Heart Surgery. Pediatr Crit Care Med. 2019; 20 (2): 149-57.
Zhao H, Wang H, Sun F, Lyu S, An Y. High-flow nasal cannula oxygen therapy is superior to conventional oxygen therapy but not to noninvasive mechanical ventilation on intubation rate: a systematic review and meta-analysis. Crit Care. 2017; 21 (1): 184.
Rochwerg B, Granton D, Wang DX, Helviz Y, Einav S, Frat JP, et al. High flow nasal cannula compared with conventional oxygen therapy for acute hypoxemic respiratory failure: a systematic review and meta-analysis. Intensive Care Med. 2019; 45 (5): 563-72.
Abboud PA, Roth PJ, Skiles CL, Stolfi A, Rowin ME. Predictors of failure in infants with viral bronchiolitis treated with high-flow, high-humidity nasal cannula therapy*. Pediatr Crit Care Med. 2012; 13 (6): e343-9.
Spentzas T, Minarik M, Patters AB, Vinson B, Stidham G. Children with respiratory distress treated with high-flow nasal cannula. J Intensive Care Med. 2009; 24 (5): 323-8.
Sztrymf B, Messika J, Bertrand F, Hurel D, Leon R, Dreyfuss D, et al. Beneficial effects of humidified high flow nasal oxygen in critical care patients: a prospective pilot study. Intensive Care Med. 2011; 37 (11): 1780-6.
Demaret P, Pettersen G, Hubert P, Teira P, Emeriaud G. The critically-ill pediatric hemato-oncology patient: epidemiology, management, and strategy of transfer to the pediatric intensive care unit. Ann Intensive Care. 2012; 2 (1): 14.
Zinter MS, Dvorak CC, Spicer A, Cowan MJ, Sapru A. New Insights Into Multicenter PICU Mortality Among Pediatric Hematopoietic Stem Cell Transplant Patients. Crit Care Med. 2015; 43 (9): 1986-94.
Rowan CM, McArthur J, Hsing DD, Gertz SJ, Smith LS, Loomis A, et al. Acute Respiratory Failure in Pediatric Hematopoietic Cell Transplantation: A Multicenter Study. Crit Care Med. 2018; 46 (10): e967-e74.
Pancera CF, Hayashi M, Fregnani JH, Negri EM, Deheinzelin D, de Camargo B. Noninvasive Ventilation in Immunocompromised Pediatric Patients: Eight Years of Experience in a Pediatric Oncology Intensive Care Unit. Journal of Pediatric Hematology/Oncology. 2008; 30 (7): 533-8.
Peters MJ, Agbeko R, Davis P, Klein N, Zenasni Z, Jones A, et al. Randomized Study of Early Continuous Positive Airways Pressure in Acute Respiratory Failure in Children With Impaired Immunity (SCARF) ISRCTN82853500. Pediatr Crit Care Med. 2018; 19 (10): 939-48.
Frat J-P, Ragot S, Girault C, Perbet S, Prat G, Boulain T, et al. Effect of non-invasive oxygenation strategies in immunocompromised patients with severe acute respiratory failure: a post-hoc analysis of a randomised trial. The Lancet Respiratory Medicine. 2016; 4 (8): 646-52.
Coudroy R, Jamet A, Petua P, Robert R, Frat JP, Thille AW. High-flow nasal cannula oxygen therapy versus noninvasive ventilation in immunocompromised patients with acute respiratory failure: an observational cohort study. Ann Intensive Care. 2016; 6 (1): 45.
Azoulay E, Lemiale V, Mokart D, Nseir S, Argaud L, Pene F, et al. Effect of High-Flow Nasal Oxygen vs Standard Oxygen on 28-Day Mortality in Immunocompromised Patients With Acute Respiratory Failure: The HIGH Randomized Clinical Trial. JAMA. 2018; 320 (20): 2099-107.
Rowan CM, Gertz SJ, McArthur J, Fitzgerald JC, Nitu ME, Loomis A, et al. Invasive Mechanical Ventilation and Mortality in Pediatric Hematopoietic Stem Cell Transplantation: A Multicenter Study. Pediatr Crit Care Med. 2016; 17 (4): 294-302.
Depuydt PO, Benoit DD, Vandewoude KH, Decruyenaere JM, Colardyn FA. Outcome in Noninvasively and Invasively Ventilated Hematologic Patients With Acute Respiratory Failure. CHEST. 2004; 126 (4): 1299-306.
Cortegiani A, Madotto F, Gregoretti C, Bellani G, Laffey JG, Pham T, et al. Immunocompromised patients with acute respiratory distress syndrome: secondary analysis of the LUNG SAFE database. Crit Care. 2018; 22 (1): 157.
Browse journals by subject