Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jan;26(1):42-47.
doi: 10.1111/nicc.12509. Epub 2020 Apr 14.

Predicting use of high-flow nasal cannula therapy following extubation in paediatrics

Deborah K White  1   2 , Esther S Daubney  1   2 , Mark E Harvey  1 , Riaz Kayani  1 , Nazima Pathan  1   2
Affiliations

Predicting use of high-flow nasal cannula therapy following extubation in paediatrics

Deborah K White et al. Nurs Crit Care. 2021 Jan.

Abstract

Background: High-flow nasal cannula (HFNC) therapy is widely used for respiratory support within paediatrics, most commonly used as a supportive measure in acute respiratory failure, aiming to avoid invasive mechanical ventilation (IMV). It is increasingly being used following extubation of critically ill children potentially at a higher risk of requiring re-intubation. Less data indicate the use for post-extubation HFNC therapy or possible clinical outcomes of this therapy.

Aims and objectives: To identify reasons for, and variables to predict, the use of HFNC therapy post-extubation.

Design: This was a retrospective case-control study.

Methods: All children admitted to a nine-bedded regional paediatric intensive care unit requiring IMV between 18 December 2017 and 28 November 2018 were identified. The demographic data and bedside clinical and laboratory variables of the patients requiring HFNC therapy were compared with those who did not require HFNC.

Results: There was no statistical difference in the median age and weight of children receiving HFNC therapy post-extubation compared with children not receiving it. In a logistic regression model, the highest ventilation (peak inspiratory pressure) and oxygen requirements in the first 24 hours of admission, along with the presence of comorbidity and use of HFNC therapy prior to intubation, predicted the use of HFNC following extubation, (r2 0.42, area under the receiver operating curve 0.843, P < .0001).

Conclusions: The direct correlation between high initial ventilatory requirements and pre-existing comorbidity was significant for the use of post-extubation HFNC therapy. This may be useful to stratify children in the use of HFNC therapy post-extubation in the critically ill population.

Relevance to clinical practice: This study provides evidence that it may be possible to predict the use of HFNC therapy post-extubation. Avoiding unnecessary use of this therapy improves patient care while providing a positive economic impact.

Keywords: critical illness; high flow; respiratory support.

PubMed Disclaimer

References

REFERENCES

    1. Milési C, Boubal M, Jacquot A, et al. High-flow nasal cannula: recommendations for daily practice in pediatrics. Ann Intensive Care. 2014;4:29.
    1. Tume LN, Kneyber MCJ, Blackwood B, Rose L. Mechanical ventilation, weaning practices, and decision making in European PICUs. Pediatr Crit Care Med. 2017;18:e182-e188.
    1. Spoletini G, Alotaibi M, Blasi F, Hill NS. Heated humidified high-flow nasal oxygen in adults: mechanisms of action and clinical implications. Chest. 2015;148:253-261.
    1. Morris JV, Kapetanstrataki M, Parslow RC, Davis PJ, Ramnarayan P. Patterns of use of heated humidified high-flow nasal cannula therapy in PICUs in the United Kingdom and Republic of Ireland*. Pediatr Crit Care Med. 2019;20:223-232.
    1. Long E, Babl FE, Duke T. Is there a role for humidified heated high-flow nasal cannula therapy in paediatric emergency departments? Emerg Med J. 2016;33(6):386-389.