The effectiveness of heated humidified high-flow nasal cannula in children with severe bacterial pneumonia in the emergency department

INTRODUCTION: The provision of appropriate respiratory support has a great role in outcome of patients presenting to the emergency department (ED) with respiratory distress (RD) associated with severe pneumonia. In recent years, heated humidified high-flow nasal cannula (HHHFNC) therapy has become one of the most popular non-invasive respiratory support modality in all pediatric settings. In this study, we aimed to assess whether the use of HHHFNC therapy is associated with reduced respiratory distress RD and improving hypoxaemia among children with severe bacterial pneumonia (SBP) presenting to the ED.
METHODS: We performed a prospective observational study of patients with SBP admitted to a tertiary children’s hospital pediatric ED and received HHHFNC therapy within 2 years study period. The primary outcome was accepted as treatment failure (It was defined as a clinical escalation in respiratory status) and increase in peripheral capillary oxygen saturation (SpO2). Secondary outcomes covered a decrease of respiratory rate (RR), heart rate (HR), and rates of weaning, intubation and intensive care unit (ICU) admission.
RESULTS: Fifty-six patients were included in the analyses. Treatment failure was 21.5% (12/56). Among this patients, 9 (16%) were intubated and 3 (5.5%) placed on bilevel positive airway pressure. The mean initial RR values were significantly higher in non-responders group than the responder group (p=0.027). Significant variation in the intubation rate or the ICU admission rate was not determined. At the 2nd hour, the falling down of RR (p<0.001), HR (p<0.001), and the increase of SpO2 (p<0.001) were significantly more evident when compared with the beginning.
DISCUSSION AND CONCLUSION: HHHFNC therapy reached treatment success in majority of the patients with SBP and provided an earlier effect. Patients with more severe RD responded less to HHHFNC. Further larger studies are needed to assess the impact of HHHFNC compared with other possible therapies.