Serial changes in oxygenation indices and arterial blood gas parameters during high flow nasal cannula therapy in children with moderate to severe respiratory distress: a prospective observational study

B. Lokeswari; B. Roshini; K. Sravani; T. Chandrasekhara Reddy

doi:10.18203/2349-3291.ijcp20263815

Authors

B. Lokeswari Sri Ramachandra Children’s and Dental Hospital, Guntur, Andhra Pradesh, India
B. Roshini Sri Ramachandra Children’s and Dental Hospital, Guntur, Andhra Pradesh, India
K. Sravani Sri Ramachandra Children’s and Dental Hospital, Guntur, Andhra Pradesh, India
T. Chandrasekhara Reddy Sri Ramachandra Children’s and Dental Hospital, Guntur, Andhra Pradesh, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20263815

Keywords:

High-flow nasal cannula, Pediatric respiratory distress, Oxygenation indices, Arterial blood gas, Pediatric intensive care unit

Abstract

Background: Aims and objectives were to evaluate the impact of high-flow nasal cannula (HFNC) therapy on ABG parameters, oxygenation indices, and clinical outcomes in children with moderate to severe respiratory distress admitted to the PICU.

Methods: This prospective observational study was conducted over 10 months at a tertiary care center. A total of 133 children aged 1 month to 14 years with respiratory distress were included. Severity was assessed using the Pediatric respiratory severity score (PRESS). Clinical and laboratory parameters were recorded at baseline, 1 hour, 12 hours, and 24 hours after initiation of HFNC therapy. Oxygenation indices, including A-a gradient, respiratory index, P/F ratio, S/F ratio, ROX index, and modified ROX index, were analyzed. Statistical analysis was performed using SPSS version 25.0.

Results: Of the 133 children, 90.23% had severe respiratory distress. Significant improvements were observed in heart rate, respiratory rate, and SpO₂ over time (p<0.05). ABG analysis showed significant reductions in pCO₂ and lactate, along with improvements in pO₂, HCO₃, and base excess (p<0.05). Both ABG-dependent and independent oxygenation indices improved significantly within 24 hours (p<0.0001). HFNC failure and need for mechanical ventilation were low (1.5% each). Median ICU and hospital stay were 4 and 6 days, respectively, with 100% survival.

Conclusions: HFNC therapy is a safe and effective non-invasive respiratory support modality in children with moderate to severe respiratory distress. It significantly improves oxygenation, ABG parameters, and clinical outcomes, while reducing the need for invasive ventilation.

References

Khemani RG, Smith LS, Zimmerman JJ, Erickson S. Pediatric acute respiratory distress syndrome: definition, incidence, and epidemiology. Pediatr Crit Care Med. 2015;16(5-1):S23-40.

Erickson S, Schibler A, Numa A, Nuthall G, Yung M, Masters IB, et al. Acute lung injury in pediatric intensive care in Australia and New Zealand. Pediatr Crit Care Med. 2007;8(4):317-23.

Slutsky AS, Ranieri VM. Ventilator-induced lung injury. N Engl J Med. 2013;369(22):2126-36.

Dysart K, Miller TL, Wolfson MR, Shaffer TH. Research in high flow therapy: mechanisms of action. Respir Med. 2009;103(10):1400-5.

Mikalsen IB, Davis P, Øymar K. High flow nasal cannula in children: a literature review. Scand J Trauma Resusc Emerg Med. 2016;24:93.

Ritchie JE, Williams AB, Gerard C, Hockey H. Evaluation of a humidified nasal high-flow oxygen system. Anaesth Intensive Care. 2011;39(6):1103-10.

Franklin D, Babl FE, Schlapbach LJ, Oakley E, Craig S, Neutze J, et al. A randomized trial of high-flow oxygen therapy in infants with bronchiolitis. N Engl J Med. 2018;378(12):1121-31.

Kepreotes E, Whitehead B, Attia J, Oldmeadow C, Collison A, Searles A, et al. High-flow warm humidified oxygen versus standard low-flow oxygen for moderate bronchiolitis. Lancet. 2017;389(10072):930-9.

Wing R, James C, Maranda LS, Armsby CC. Use of high-flow nasal cannula support in the emergency department reduces the need for intubation in pediatric acute respiratory insufficiency. Pediatr Emerg Care. 2012;28(11):1117-23.

Chang CC, Lin YC, Chen TC, Lin JJ, Hsia SH, Chan OW, Lee EP. High-flow nasal cannula therapy in children with acute respiratory distress with hypoxia in a pediatric intensive care unit: a single center experience. Front Pediatr. 2021;9:664180.

Milési C, Boubal M, Jacquot A, Baleine J, Durand S, Odena MP, et al. High-flow nasal cannula: recommendations for daily practice in pediatrics. Clin Med Insights Pediatr. 2016;10:43-51.

Mayordomo-Colunga J, Pons M, Medina A, Rey C, Concha A, Arcos ML, et al. Predicting success and failure of high-flow nasal cannula in pediatric intensive care patients. Pediatr Pulmonol. 2019;54(10):1519-26.

Lodeserto FJ, Lettich TM, Rezaie SR. High-flow nasal cannula: mechanisms of action and adult and pediatric indications. Cureus. 2018;10:e3639.

Kelly GS, Simon HK, Sturm JJ. High-flow nasal cannula use in children with respiratory distress in the emergency department: predicting the need for subsequent intubation. Pediatr Emerg Care. 2013;29(8):888-92.

Webb lV, Chahine R, Aban I, Prabhakaran P, Loberger JM. Predicting High-Flow Nasal Cannula Therapy Outcomes Using the ROX-HR Index in the Pediatric ICU. Respiratory Care Nov 2022;67(11):1377-84.

Kim JH, Suh DI, Park JD. S/F and ROX indices in predicting failure of high-flow nasal cannula in children. Pediatr Int. 2022;64(1):e15336.