High-flow nasal cannula versus conventional oxygen therapy in children with respiratory distress

IntroductIonRespiratory distress is one of the most common causes of hospitalization in children worldwide.[1] Various forms of oxygen therapy are used to treat children who have respiratory distress.Oxygen supplement by nasal cannula in infants and children is limited by flow due to insufficient humidification.If oxygen flow was used more than 2-6 L/min, it will make cool and dry the airway.[2,3] Noninvasive positive pressure ventilation was proved to reduce the need for endotracheal tube intubation, but it could make patient discomfort.Mechanical ventilation through an endotracheal tube is another choice for acute respiratory failure, but it could be associated with various complications, including nosocomial pneumonia and prolonged pediatric Intensive Care Unit (PICU) stay.Currently, high-flow nasal cannula (HFNC) therapy has been increasingly used in a variety of clinical settings.[4][5][6] It can deliver heated and humidified oxygen to the nose at a high-flow rate and adjust the fraction of inspired oxygen (FiO 2 ) by changing the fraction of oxygen in the driving gas.It could reduce work of breathing by providing adequate flow, supplying adequately warmed and humidified gas, washing out of nasopharyngeal dead space, and providing distending pressure.[7][8][9] It was recently studied in a preterm neonate with respiratory distress syndrome and revealed that it was able to reduce the intubation rate.[10] In addition, there was evidence that using HFNC in acute bronchiolitis could reduce intubation rate.[11] Purpose: The aim of this study is to determine the clinical efficacy of high-flow nasal cannula (HFNC) therapy compared with conventional oxygen therapy in children presented with respiratory distress.Study Design: This was a randomized controlled study.Materials and Methods: Infants and children aged between 1 month to 5 years who were admitted to our tertiary referral center for respiratory distress (July 1, 2014 to March 31, 2015) and met the inclusion criteria were recruited.Interventions: Infants and children hospitalized with respiratory distress were randomized into two groups of interventions.All clinical data, for example, respiratory score, pulse rate, and respiratory rate were recorded.The results were subsequently analyzed.Results: A total of 98 respiratory distress children were enrolled during the study period.Only 4 children (8.2%) failed in HFNC therapy, compared with 10 children (20.4%) in conventional oxygen therapy group (P = 0.09).After adjusted for body weight, underlying diseases, and respiratory distress score, there was an 85% reduction in the odds of treatment failure in HFNC therapy group (adjusted odds ratio 0.15, 95% confidence interval 0.03-0.66,P = 0.01).Most children in HFNC therapy group had significant improvement in clinical respiratory score, heart rate, and respiratory rate at 240, 360, and 120 min compared with conventional oxygen therapy (P = 0.03, 0.04, and 0.03).Conclusion: HFNC therapy revealed a potential clinical advantage in management children hospitalized with respiratory distress compared with conventional respiratory therapy.The early use of HFNC in children with moderate-to-severe respiratory distress may prevent endotracheal tube intubation.Trial Register: TCTR 20170222007.