Efficacies of High Flow Nasal Cannula Versus Conventional Oxygen Therapy in PICU Patients

The aim of a new study was to compare the effectiveness of a high-flow nasal cannula (HFNC) and conventional oxygen therapy (COT) – using a simple nasal cannula for respiratory support in critically ill children following extubation. The primary focus was on the rate of post-extubation airway obstruction (PEAO).

This open-labeled, randomized controlled trial was undertaken in a pediatric intensive care unit (PICU) of a tertiary care teaching hospital in North India––over seven months (until March 2022). The trial included children aged 3 months to 12 years – who required invasive mechanical ventilation for over 72 hours and were ready for extubation after passing a spontaneous breathing trial. Participants were randomized into two groups – receiving either HFNC or COT after extubation. The primary outcome was the rate of PEAO within 48 hours of extubation. Secondary outcomes included the frequency of adrenaline nebulization, treatment failure (necessitating escalation of respiratory support), extubation failure, adverse events, and PICU stay duration.

Overall, 116 children were enrolled––58 in each group. No significant difference was observed between the HFNC and COT groups regarding PEAO rate (55% vs. 51.7%, respectively), adrenaline nebulization needs, extubation failure, adverse events, or PICU stay duration. Notably, the HFNC group had a significantly lower rate of treatment failure requiring escalation of respiratory support (27.6% vs. 48.3%).

While the rate of PEAO was similar between HFNC and COT groups, HFNC rendered a significantly lower treatment failure rate.

Source: Sudeep KC, Angurana SK, Nallasamy K, et al. Indian Journal of Pediatrics. 2024 Aug 5:1-7.