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The Clinical Impact of Heated Humidified High-Flow Nasal Cannula on Pediatric Respiratory Distress

Kawaguchi, Atsushi MD; Yasui, Yutaka PhD; deCaen, Allan MD; Garros, Daniel MD

Pediatric Critical Care Medicine: February 2017 - Volume 18 - Issue 2 - p 112–119
doi: 10.1097/PCC.0000000000000985
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Objectives: To assess the impact on a single PICU of introducing high-flow nasal cannula as a management tool for respiratory distress.

Design: Retrospective cohort study, including an interrupted time series analysis with a propensity score adjustment and a matched-pair analysis.

Setting: A single university-affiliated children's hospital PICU.

Interventions: None.

Measurements and Main Results: Differences in clinical outcomes when comparing the pre–high-flow nasal cannula era (2004–2008) and the high-flow nasal cannula era (2010–2014), excluding 2009 as a washout period, and clinical impacts of high-flow nasal cannula as an exposure of interest. A total of 1,766 children met the inclusion criteria (pre–high-flow nasal cannula era: 699 patients; high-flow nasal cannula era: 1,067 patients). High-flow nasal cannula was used in 455 patients (42.6%) in the high-flow nasal cannula era. The interrupted time series analysis failed to show a statistically significant difference in PICU length of stay, but the duration of invasive ventilation was shortened by an average of 2.3 days in the high-flow nasal cannula era group (95% CI, 0.2–4.4; p = 0.030). The PICU intubation rate in the high-flow nasal cannula era was 0.72 times that of the pre–high-flow nasal cannula era (95% CI, 0.63–0.84; p < 0.001). A total of 373 pairs were formed for the matched-pair analysis. The odds for being intubated in the PICU for those patients using high-flow nasal cannula was 0.06 (95% CI, 0.02–0.16; p < 0.001) when compared with those who did not use high-flow nasal cannula. The PICU length of stay increased by 2.9 days in those patients in which high-flow nasal cannula was used (95% CI, 1.3–4.4; p < 0.001).

Conclusions: The introduction of high-flow nasal cannula as a therapy for respiratory distress in the PICU was associated with a significant decrease in the PICU intubation rate with no associated change in mortality.

Supplemental Digital Content is available in the text.

1Department of Pediatrics, Pediatric Critical Care Medicine, University of Alberta, Edmonton, AB.

2School of Public Health, University of Alberta, Edmonton, AB.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/pccmjournal).

Dr. Kawaguchi conceptualized and designed the study, conducted data collection and cleaned the data, carried out analysis, drafted the initial article, revised the initial article, and approved the final article as submitted. Dr. Yasui supervised data analysis and approved the final data analysis, reviewed and revised the initial article, and approved the final article as submitted. Dr. deCaen reviewed and revised the initial article, and approved the final article as submitted. Dr. Garros conceptualized the study, supervised and gathered the original dataset, reviewed and revised the initial article, and approved the final article as submitted.

Dr. Kawaguchi was supported by a Graduate Studentship Award from the Women and Children’s Health Research Institute. The remaining authors have disclosed that they does not have any potential conflicts of interest.

For information regarding this article, E-mail: atsushi@ualberta.ca

©2017The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies