Evaluation of patients treated with high flow nasal cannule oxygenization in A pediatric intensive care unit

Introduction: Patients hospitalized in pediatric intensive care units (PICU) require respiratory support treatment at various rates. Invasive and non-invasive treatment methods are used as respiratory support therapy. Non-invasive mechanical ventilation methods carry less risk of complications compared to invasive methods. With the introduction of "High flow nasal cannula oxygenation" (HFNCO) therapy, which is designed as a new oxygen delivery method today, but can also be considered as a non-invasive ventilation method due to its many additional features other than oxygen delivery, studies have begun to investigate the effectiveness of HFNCO therapy in acute respiratory support. In this study, it was aimed to evaluate the efficacy of ROX Index from arterial blood gas taken at the 2nd hour, 6th hour, 12th hour, 18th hour and 24th hour after starting HFNCO therapy in the pediatric intensive care unit of our hospital. Material and method: The study included 84 patients who were hospitalized in the pediatric intensive care unit of the Fırat University Hospital Pediatrics Clinic between 01.01.2019-01.01.2021 who met the study criteria, who were treated with HFNCO. In the study, demographic characteristics of the patients, PICU hospitalization diagnoses, length of hospitalization, presence of concomitant chronic diseases, PRISM-2 (Pediatric Risk Of Mortality Score) score, HFNCO treatment duration, 2nd hour, 6th hour, 12th hour, 18th hour and 24th hour arterial blood gas values, whether complications developed during the treatment period and the presence of mortality were recorded. Results: Of the 84 patients included in the study, 38.09% of the patients were female and 61.90% were male, with a median age of 50,14 (1,3- 98,6) months. The reason for admission to the pediatric intensive care unit of the patients included in the study was pneumonia in 28 patients (33,3%), asthma/bronchiolitis in 19 patients (22,6%), sepsis in 9 patients (10,7%), heart failure in 6 patients (7,1%), stridor/respiratory distress after extubation in 19 patients (22,6%) and other causes in 3 patients (3,6%). There was a history of underlying chronic disease in 29,7% (25 patients) of the patients, and neuromotor disease was the most common 8,3% (7 patients). 12 (14,2%) of the patients who were started on HFNCO treatment after oxygen therapy with a reservoir mask did not benefit from the treatment and were intubated. In general, HFNCO treatment was considered successful in 66 (78,5%) patients, while it was considered unsuccessful in 18 (21,4%) patients. The mean duration of hospitalization in the intensive care unit was 14,5 (2-94) days. During the treatment period, complications were observed in 3 patients (3,57%), pneumothorax in 2 patients and abdominal distension in 1 patient. When the patients who were successful in high flow nasal cannula oxygenation therapy and the patients who were unsuccessful were compared; There was no significant difference in gender, age of the patient, reason for hospitalization, HFNCO indication, presence of underlying chronic disease. Conclusion: High flow nasal cannula oxygenation therapy is an important treatment method that can be used in children with respiratory distress and insufficiency. Studies on high flow nasal cannula oxygenation therapy in terms of treatment effectiveness, safety and indications for use are not yet sufficient in terms of numbers and scientific evidence. Multicenter randomized controlled studies are needed in different patient groups to evaluate the efficacy and complications of HFNCO treatment.