Evaluation of the efficacy of HİGH flow nasal cannula oxygen therapy in the pediatric emergency department and pediatric intensive care unit

Objective: The most important treatment step in respiratory failure is oxygen. High flow nasal cannula oxygen therapy (HFNC), which is given as heated and humidified, is a method that is increasingly used in children with respiratory distress all over the world. It is preferred in many indications, especially acute bronchiolitis in children. In our study, we aimed to evaluate the change in vital signs, the effectiveness of the treatment and the success of the treatment in patients who received high-flow nasal cannula oxygen therapy for respiratory distress and respiratory failure in the pediatric emergency service and pediatric intensive care unit. Material and Methods: Patients aged 1 month to 18 years, who were followed up in the Pediatric Emergency Service and Pediatric Intensive Care Unit in Manisa Celal Bayar University Hafsa Sultan Hospital Pediatric Clinic between 1 October 2018 and 1 July 2020, were included in the study. The complete blood count, biochemistry, blood gas tests and the hospital system were recorded from the patients within the indications. GCS, respiratory rate, mRDAI score, peak heart rate, oxygen saturation, and S/F ratio were recorded before and 1 hour after the start of high-flow nasal cannula oxygen therapy. Demographic characteristics of the patients, indication for HFNC treatment, underlying chronic diseases, treatment success, duration of treatment, length of hospital stay, and mortality were recorded in the data recording form. Statistical analysis of the research was performed by entering the data obtained into the SPSS form. Results: Of the 191 cases included in the study, 121 (63,4%) were male and 70 (36,6%) were female. The mean age was 37,53±51,89 months. The mean body weight was 13,51±11,07 kg. The most common indication for HFNCO treatment was bronchopneumonia (n=83, 43,5%). According to HFNCO treatment indication, the 3 most successful patient groups were asthma (100%), croup (100%) and acute bronchiolitis (98%). While 53,4% (n=102) of the cases had an underlying chronic disease, the most common chronic disease (18,6% n=19) was chronic lung disease/bronchopulmonary dysplasia. HFNCO treatment was successful in 81,7% (n=156) of the cases. In all cases, a significant difference was observed in heart rate, respiratory rate, SpO2, GCS, mRDAI score, SpO2/FiO2 at the first hour of HFNCO treatment (p<0.05). In 156 patients who were successful in HFNCO treatment, a significant difference was observed in heart rate, respiratory rate, SpO2, GCS, mRDAI score, SpO2/FiO2 at the first hour of treatment (p<0.05). There was a significant difference in GCS at the first hour of treatment in 35 patients who failed HFNCO treatment (p<0.05). When the 1st hour blood gas parameters of the cases who were successful in HFNCO treatment were examined, a statistically significant difference was observed in the pH, pCO2, HCO3 and lactate values (p<0.05). When the 1st hour blood gas parameters of the patients who failed HFNCO treatment were examined, a statistically significant difference was found in the lactate value (p<0.05). When the successful and unsuccessful groups were compared in terms of length of hospital stay, a statistically significant difference was found between them (p<0.05). When the patients with and without an underlying chronic disease were compared in terms of length of stay in hospital, there was a statistically significant difference between them (p<0.05). During HFNCO treatment, 28 (14,7%) of 191 cases required invasive mechanical ventilation, 7 (3,7%) required non-invasive mechanical ventilation. No case died during HFNCO treatment. Conclusion: It is known that the use of high-flow nasal cannula oxygen therapy in respiratory failure in the pediatric age group has been increasing in recent years. HFNCO treatment; It is a non-invasive, simple, effective, easily tolerated and easy-to-use oxygen delivery method by children. However, more comprehensive, randomized and controlled studies are needed to determine its safety and efficacy more precisely, to know the factors affecting the failure of HFNCO treatment, to provide early transition to other treatment modalities, and to reduce the length of hospital stay and cost. Keywords: Child, respiratory distress, High-flow nasal cannula oxygen