Predictive Factors for Failure of High-Flow Nasal Cannula Therapy in Pediatric Intensive Care Unit

Objective: High-flow nasal cannula (HFNC) therapy is widely used to manage respiratory distress in children.However, treatment failure requiring advanced respiratory support is associated with increased rates of morbidity and mortality.Identifying predictive factors for HFNC failure is crucial for optimizing patient outcomes.This study aimed to determine the predictive factors associated with HFNC therapy failure in pediatric patients with moderate to severe respiratory distress managed in the pediatric intensive care units (PICU). Method:This cross-sectional study included patients aged one month to 18 years with moderate to severe respiratory distress treated with HFNC therapy in the PICU between October 2018 and January 2020.Patients with chronic lung disease or cyanotic congenital heart disease were excluded from the analysis.Clinical and laboratory data, including modified Respiratory Distress Assessment Instrument (mRDAI) scores and treatment outcomes, were analyzed.Statistical methods including Mann-Whitney U test, 2 test, receiver operating characteristic curve and multivariate logistic regression analyses were used.Results: Analysis of 114 patients revealed an HFNC treatment failure rate of 31.6%.Multivariate logistic regression analysis revealed that the presence of medical comorbidities [odds ratio (OR): 25.8; 95% confidence interval (CI): 2.61-254.5;p=0.005], an increased mRDAI scores at the first hour of HFNC therapy (OR: 2.9, 95% CI: 1.32-6.48,p=0.008), and higher pediatric risk of mortality (PRISM) (OR: 2.1, 95% CI: 1.44-3.07,p<0.001) were significant predictors of HFNC failure. Conclusion:Early identification of predictive factors such as medical comorbidities, mRDAI and PRISM scores can help improve management strategies and outcomes for pediatric patients with respiratory distress undergoing HFNC therapy.