Nasal high flow therapy introduction lowers reintubation risk in a Peruvian paediatric intensive care unit. (17th April 2020)

• Record Type: Journal Article
• Authors: Nielsen, Katie R.; Becerra, María R.; Mallma, Gabriela; Ellington, Laura E.; Onchiri, Frankline; Roberts, Joan S.; Zunt, Joseph; Tantaleán da Fieno, José
• Is Part Of: Acta pædiatrica. Volume 109:Number 12(2020)
• Page Start: 2748
• Page End: 2754
• Publication Date: 2020-04-17
• Subjects: critical care outcomes -- implementation science -- non‐invasive ventilation -- reintubation -- respiratory failure; Pediatrics -- Periodicals; Pediatrics; 618.92
• DOI: 10.1111/apa.15265
• Languages: English
• ISSNs: 0803-5253

Abstract

Abstract: Aim: We examined the impact of introducing high‐flow nasal oxygen therapy (HFNT) on children under five with post‐extubation respiratory failure in a paediatric intensive care unit (PICU) in Peru. Methods: This quasi‐experimental study compared clinical outcomes before and after initial HFNT deployment in the PICU at Instituto Nacional de Salud del Niño in Lima in June 2016. We compared three groups: 29 received post‐extubation HFNT and 17 received continuous positive airway pressure (CPAP) from 2016‐17 and 12 historical controls received CPAP from 2012‐16. The primary outcome was the need for mechanical ventilation. Adjusted hazard ratios (aHR) and 95% confidence intervals (95% CI) were calculated via survival analysis. Results: High‐flow nasal oxygen therapy and CPAP did not alter the need for mechanical ventilation after extubation (aHR 0.47, 95% CI 0.15‐1.48 and 0.96, 95% CI 0.35‐2.62, respectively) but did reduce the risk of reintubation (aHR 0.18, 95% CI 0.06‐0.57 and 0.14, 95% CI 0.03‐0.72, respectively). PICU length of stay was 11, 18 and 37 days for CPAP, HFNT and historical CPAP and mortality was 12%, 7% and 27%, respectively. There was no effect on the duration of sedative infusions. Conclusion: High‐flow nasal oxygen therapy provided effective support for some children, but larger studies in resource‐constrained settings are needed.