The Effectiveness of Heated Humidified High-flow Nasal Cannula in Children with Severe Bacterial Pneumonia in the Emergency Department

Özet

Aim: 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 modalities in all pediatric settings. In this study, we aimedto assess whether the use of HHHFNC therapy is associated with reduced RD and improvements in hypoxemia among children with severebacterial pneumonia (SBP) presenting to the ED.Materials and Methods: We performed a prospective observational study of patients with SBP admitted to a tertiary children’s hospitalpediatric ED who received HHHFNC therapy within the 2 year study period. The primary outcome was accepted as treatment failure (It wasdefined as a clinical escalation in respiratory status) and an increase in peripheral capillary oxygen saturation (SpO2). Secondary outcomescovered 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 this analyses. Treatment failure was 21.5% (12/56). Among these patients, 9 (16%) were intubatedand 3 (5.5%) placed on bilevel positive airway pressure. The mean initial RR values were significantly higher in the non responders group thanthe responder group (p=0.027). Significant variation in the intubation rate or the ICU admission rate was not determined. At the 2nd hour, thefall in RR (p<0.001), HR (p<0.001), and the increase of SpO2 (p<0.001) were significantly evident when compared with the beginning.Conclusion: HHHFNC therapy reached treatment success in a majority of the patients with SBP and provided an early effect. Patients withhigher RRs responded less to HHHFNC. Further larger studies are needed to assess the impact of HHHFNC compared with other possibletherapies.