High-flow nasal cannula use in a paediatric intensive care unit over 3 years

Objective: High-flow nasal cannula (HFNC) therapy is increasingly used in paediatric intensive care unit (PICU) patients, despite a paucity of studies. We describe its use over the 3 years since its implementation in our tertiary intensive care unit. Design: The clinical database was used to identify PICU patients on HFNC therapy from 2011 to 2013. Patients were assessed for risk factors, underlying diagnosis, viral test results and cardiorespiratory parameters before and after HFNC therapy. Results: Fifty-four children were included with a median age of 3.5 months (interquartile range DORE 1-10 months) and 59% were females. The commonest diagnosis was bronchiolitis (79%). HFNC therapy was successful in 78% of patients and failed for 12 (seven patients went on to CPAP treatment and five were intubated). The median time to HFNC therapy failure was 5.5 hours (IQR, 3.6-9 hours), with 75% of patients experiencing therapy failure by 8.25 hours. The failure rate was 50% in children with a primary diagnosis of congenital heart disease. There was a statistically significant difference between the mean respiratory rate at 1 hour in the success and failure groups (P = 0.037), despite similar respiratory rates at onset. HFNC therapy failure was associated with a longer PICU LOS (P 0.04). Conclusion: HFNC therapy was successful in most patients. Most failures occurred within 8.25 hours. Use of HFNC for heart disease was associated with a high therapy failure rate (50%).