High-flow nasal cannula therapy in paediatric intensive care: Indications, efficacy and predictors of failure

Objectives: High-flow nasal cannula (HFNC) is increasingly being used as a non-invasive substitute for traditional oxygen therapy and mechanical ventilation in children with respiratory distress. By delivering heated and humidified oxygen at high flow rates, it improves oxygenation and reduces the work of breathing. The objective of the study is to assess the indications, effectiveness and safety of HFNC therapy in children admitted with respiratory distress in a paediatric intensive care unit (PICU). Material and Methods: This was a prospective observational study conducted over 1 year at the PICU of a tertiary care hospital in Mangalore, India. All children presenting with respiratory distress and initiated on HFNC therapy were included. Demographic, clinical and laboratory data were recorded. HFNC outcomes were categorised as success or failure (defined as escalation to non-invasive or invasive ventilation after initiation of HFNC). Risk factors associated with failure were analysed. Results: A total of 29 children were included. The majority were infants (45%, n = 13), and 65.5% ( n = 19) were male. The most common indication for HFNC was bronchopneumonia (41.3%, n = 12), followed by aspiration pneumonia and wheezing disorders. HFNC therapy was successful in 82.8% ( n = 24) of cases. Mild complications included nasal erythema and epistaxis. Factors associated with HFNC failure included acute respiratory distress syndrome, presence of comorbidities (neurological/cardiac), multiple organ dysfunction syndromes - including renal failure, severe metabolic acidosis and need for inotropes. Conclusion: HFNC therapy is an effective and well-tolerated non-invasive respiratory support modality for children with respiratory distress across a spectrum of aetiologies. Identification of risk factors for failure may help in early escalation of care.