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Evaluation of efficacy and failure of high flow nasal cannula therapy in paediatric emergency service and paediatric intensive care unit

Objective: High-flow nasal cannula oxygen therapy (HFNC) improves gas exchange and decreases work of breathing in patients with acute respiratory distress. We aimed to discuss the indications for HFNC in children of all ages and diagnoses and to evaluate the efficacy and risk factors for failure of HFNC therapy in children with acute respiratory distress and failure in a paediatric emergency service and paediatric intensive care unit (PICU).
Material and Methods: A total of 191 patients aged one month to 18 years treated with HFNC between October 1, 2018, and July 1, 2020, in the Paediatric Emergency Service and PICU were included in the study. Demographic and clinical characteristics, underlying chronic diseases, HFNC treatment success, and treatment failure of the cases were recorded.  
Results: One hundred ninety-one children were included in the study, of whom 70 (36.6%) were female, and the median age was 13 months (1-204). The most common indication of HFNC treatment was bronchopneumonia (n=83, 43,5 %). HFNC treatment succeeded in 81.7 % (n=156) of the patients. It was observed that the two most successful patient groups were acute bronchiolitis and pneumonia. The failure rate was 18.3 % (35 of 191 children). The most common underlying comorbidity was bronchopulmonary dysplasia (BPD) (19, 9.9%). There was a statistically significant difference seen on Glasgow Coma Scale (GCS) and lactate value in blood gas in the first hour of the treatment in the group with unsuccessful results (p<0.05). During the HFNC treatment, 28 patients (14.7%) required invasive mechanical ventilation (IMV), and seven patients (3.7%) required non-invasive mechanical ventilation (NIMV).
Conclusion: HFNC is a reliable non-invasive treatment modality that is easily tolerated by children and has effective use in many critical diseases. Our study found that HFNC therapy could be initiated as the first-line therapy for various aetiologies of acute respiratory distress in a paediatric emergency service and PICU and all age groups. It was emphasized that transition to other treatment modalities should not be delayed in the cases predicted to be unsuccessful.