Effectiveness of the Protocol for Initiating and Weaning High-Flow Nasal Cannula Oxygen Therapy in Pediatrics Patients with Respiratory Distress from Respiratory Tract Infection
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Abstract
Background: High-Flow Nasal Cannula (HFNC) is a non-invasive respiratory support method that has been accepted in the treatment of pediatric patients with respiratory distress from various causes, as it is effective in reducing the rate of endotracheal intubation. Its use is increasing in community hospitals, but there is a lack of clear protocol for its initiation and weaning. Therefore, pediatricians have developed a protocol.
Objective: To study the effectiveness of the HFNC initiation and weaning protocol in reducing the duration of HFNC use.
Methodology: This was a retrospective observational cohort study involving pediatric patients aged older than 1 month to younger than 15 years, presenting with respiratory distress due to respiratory tract infections or acute asthma exacerbation. The patients were treated with HFNC in the pediatric inpatient ward at Khumuang Hospital, Buriram Province, from July 2021 to June 2024. Baseline characteristics were analyzed using descriptive statistics, including proportions, means and median. Differences between groups were compared using the t-test and Fisher’s exact test. The effectiveness of protocol was analyzed using multivariable regression to adjust for potential confounding variables.
Results: Patients used HFNC: 79 utilized the protocol and 135 did not. There were no differences in sex, age and weight. The diagnoses differed significantly: croup (7.6%, 0%, p = 0.002), bronchitis (20.3%, 8.9%, p = 0.021), and pneumonia (48.1%, 63%, p = 0.045). After adjusting variables using multivariable regression, the group utilizing the protocol showed a reduction in total HFNC duration by 11.4 hours (95% CI –20.68, –2.03, p=0.017), HFNC weaning duration by 10.6 hours (95% CI –18.62, –2.61, p=0.009), length of hospital stays by 15.6 hours (95% CI –28.09, –3.15, p=0.014).
Conclusion: The developed HFNC initiation and weaning protocol helps reduce the duration of high-flow oxygen use and shortens the length of hospital stay.
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