Background High-flow nasal cannula (HFNC) is a non-invasive positive pressure ventilation which delivers adjustable mixture of heated and humidified air and oxygen at rates that exceed spontaneous inspiratory flow. It’s easy to initiate, relatively safe, and usually well tolerated by children (1). A lot of studies have suggested that HFNC may reduce the work of breathing (1). Early initiation of HFNC has been associated with reduced rate of endotracheal intubation.
Objectives This study aims to provide an overview of HFNC usage in paediatrics general ward setting, outside ICU setting.
Methods A retrospective study was carried out to evaluate the usage of HFNC in paediatric patients in HSIP general ward settings from April 2019 to March 2020.
Results A total of 177 children’s record (boys: 112, girls: 65, age: 1 month to 12 years old) were analysed. A total of 112 patients were referral from district hospital, while 55 patients were referral from our emergency department.
From the analysis, we noted the age group of 12 to 24 months had the highest number of admissions requiring HFNC. Most of the patients were put on HFNC immediately upon admission to ward. The duration of its usage ranges from 2–4 days [interquartile range (IQR)], with median of 3 days. Length of hospital stay were 6 days (IQR: 4 to 8 days). Multiple linear regression analysis showed that duration of HFNC usage and delaying its initiation >6 hours were associated with significantly longer hospital stay (p-value <0.001).
Among the indications for the usage of HFNC, pneumonia is the main cause, followed by acute bronchiolitis, heart failure, sepsis and laryngomalacia. Almost one third (38%) of the patients that required HFNC had underlying disease(s), mainly respiratory disease. SpO2 on arrival were mostly 96% (IQR: 92 to 99%). Respiratory rates were analysed according to age group as well.
The median white cell count (WCC) is 12.96 × 103/uL (IQR: 9.67 to 17.27), while C-reactive protein (CRP) is 22 mg/L (IQR: 10.91 to 52.62). Linear regression was used to analyse the correlation between these two parameters, which showed that WCC and CRP are two independent variables.
Nasopharyngeal aspiration (NPA) for viruses sent yielded 24% positive culture. Among the viruses detected, RSV accounted for 66% of the positive culture.
As for outcome, 98% (N=174) of them recovered well while 3% (N=3) required escalation of therapy to BIPAP and intubation. Unfortunately, 3 patients succumbed to death in which one had severe malnourished and the other two patients with had congenital cyanotic heart with prolonged hospital stay. No major adverse effect was reported but 1 patient had minor burn on cheeks.
Conclusions HFNC is an excellent choice of NIV in providing respiratory support in district hospital with no or very limited intensive care unit. Our study showed that it is relatively safe to use with regular vital signs monitoring, with occasionally some patients requiring continuous SpO2 monitoring. Detailed studies on its indication, safety protocol and cost effectiveness are needed to improve the outcome of patients.
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