# The Effectiveness of High-Flow Nasal Cannula in Respiratory Distress in the Pediatric Population of Bundelkhand Region: An Observational Study

## TL;DR

This study shows that high-flow nasal cannula is effective for treating respiratory distress in children, reducing the need for invasive ventilation.

## Contribution

The study evaluates HFNC effectiveness in a specific pediatric population in the Bundelkhand region.

## Key findings

- HFNC had an 87% success rate in treating respiratory distress in 100 pediatric patients.
- Patients who responded well to HFNC had a shorter hospital stay compared to those who failed HFNC.
- Lower ROX indices and higher oxygen levels were linked to HFNC failure and need for intubation.

## Abstract

Introduction: Respiratory distress is the most frequently encountered cause of admission in the pediatric intensive care unit (PICU) requiring immediate medical attention. Standard oxygen therapy is provided via traditional nasal cannula, oxygen mask, or oxygen hood, whose failure warrants the need for invasive mechanical ventilation. High-flow nasal cannula (HFNC) is increasingly being used as a form of noninvasive respiratory support with fewer side effects and has been shown to reduce the requirement for intubation.

Objectives: To evaluate the effectiveness of HFNC in various indications of respiratory distress and its effect on the length of hospital stay and further complications associated with it.

Method: We conducted a prospective observational study at our tertiary PICU between May 2023 and April 2024. Patients aged one month to 18 years with respiratory distress were initially administered standard oxygen therapy escalating to HFNC upon failure. The clinical data and investigations were reviewed.

Result: Among 100 pediatric patients presenting with respiratory distress, 53 were males, with a male-to-female ratio of 1.13:1, and a median age of two years, ranging from three months to 15 years. The most common indication for HFNC was bronchopneumonia (44, 44%), bronchiolitis (31, 31%), asthma (8, 8%), wheeze-associated lower respiratory tract infections (WALRI) (7, 7%), post-extubation (7, 7%), and congenital heart disease with respiratory distress (CHD) without congestive heart failure (CHF) (3, 3%). The overall success rate of HFNC therapy was 87 (87%). The average duration of stay among the success group was 8.69 + -2.26 days, and the failure group was 10.00 + -3.44 days. The average duration of HFNC was markedly longer in the success group (59.39 + -19.84 days) as compared to the failure group (5.69 + -2.02 hours). Factors associated with HFNC failure and the need for invasive ventilation included lower initial and minimum respiratory rate-oxygenation (ROX) indices, as well as higher initial and maximum fraction of inspired oxygen levels.

Conclusion: HFNC can be employed as the first line of noninvasive oxygen therapy in cases of respiratory distress, offering an efficient and compassionate alternative that may significantly reduce the incidence of mechanical ventilation.