Predicting high-flow nasal cannula therapy failure in pediatrics: A retrospective analysis of prevalence and risk factors in tertiary care hospital

BACKGROUND High-flow nasal cannula (HFNC) is extensively used as an effective noninvasive respiratory support for children experiencing acute respiratory distress. However, some may develop HFNC failure, which can lead to delayed intubation, resulting in higher morbidity and mortality.OBJECTIVE The objective of this study was to assess the prevalence of HFNC failure and identify factors associated with HFNC failure in children.METHODS We conducted a retrospective study between January 2022 and December 2023. The demographic data, medical history, diagnosis, pediatric early warning score (PEWS), chest X-ray findings, heart rate and respiratory rate (RR) at initial, 1 h and 2 h after initiating HFNC were recorded. The factors associated with HFNC failure were analyzed using multivariable logistic regression analysis.RESULTS Of those 340 children receiving HFNC, the median age was 29.7 (interquartile range, IQR 13.4–51.6) months. Pneumonia was the most common indication for HFNC. The prevalence of HFNC failure was 7.3% with a median time of HFNC failure at 10 (IQR 3–15) hours. The independent factors associated with HFNC failure were children with age less than 12 months (p = 0.047), sepsis (p = 0.01), congenital heart disease comorbidity (p = 0.027), patchy infiltration (p = 0.027) and initial PEWS ≥ 5 points (p = <0.001)CONCLUSION HFNC is an effective treatment option for children with respiratory distress; however, children under 12 months of age, sepsis, congenital heart disease, patchy infiltration and initial PEWS ≥ 5 points should be closely monitored.