Comparison between high-flow nasal oxygen cannula and conventional oxygen therapy after extubation in pediatric intensive care unit

Abstract

The aim of this study was to compare the efficiency, safety, and outcomesof the high-flow nasal oxygen cannula (HFNC) and conventional oxygentherapy (COT) after extubation in children. A randomized controlled trial wasconducted in a 13 bed pediatric intensive care unit. One-hundred childrenwho underwent extubation were eligible for the study. Patients were dividedinto HFNC (n=50) and COT (n=50) groups. Basal variables including heartrate (HR), noninvasive blood pressure, respiratory rate (RR), SpO2, SpO2/FiO2(SF) ratio, and end tidal CO2 (EtCO2) were obtained initially and recordedat 15, 30, and 45 minutes and at 1, 6, 12 hours, 24 and 48 hours afterextubation. SF ratio and SpO2 increased during the first hour in the HFNCgroup (p=0.005 and p=0.03, respectively). HR and RR decreased duringfollow-up in the HFNC group (p=0.001 and p=0.048, respectively). Therewas no statistically significant difference for PCO2 after extubation betweenthe two groups. PCO2 (p=0.008) and EtCO2 (p=0.018) values at 24-h weredifferent between two groups. At follow-up, HR decreased only in the HFNCgroup (p=0.001) and was different at 12 and 48 hours (p=0.047 and p=0.01,respectively). Initial modified radiologic atelectasis scores (m-RAS) were higherfor the HFNC group and decreased steadily (p=0.001). Extubation failure rateswere 4% and 22% for the HFNC and COT groups, respectively (p=0.007).In conclusion, HFNC is better than COT, especially for the restoration of therespiratory and radiologic parameters. Although more expensive, the use ofHFNC may have more advantages to reduce the risk of extubation failure incritically ill children compared with COT.