Analysis of risk factors for the failure of respiratory support with high-flow nasal cannula oxygen therapy in children with acute respiratory dysfunction: A case–control study
BackgroundEvidence-based clinical practice guidelines regarding high-flow nasal cannula (HFNC) use for respiratory support in critically ill children are lacking. Therefore, we aimed to determine the risk factors for early HFNC failure to reduce the failure rate and prevent adverse consequences of H...
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| Format: | Article |
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Frontiers Media S.A.
2022-08-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2022.979944/full |
| _version_ | 1811339647328976896 |
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| author | Jie Liu Jie Liu Deyuan Li Deyuan Li Lili Luo Lili Luo Zhongqiang Liu Zhongqiang Liu Xiaoqing Li Xiaoqing Li Lina Qiao Lina Qiao |
| author_facet | Jie Liu Jie Liu Deyuan Li Deyuan Li Lili Luo Lili Luo Zhongqiang Liu Zhongqiang Liu Xiaoqing Li Xiaoqing Li Lina Qiao Lina Qiao |
| author_sort | Jie Liu |
| collection | DOAJ |
| description | BackgroundEvidence-based clinical practice guidelines regarding high-flow nasal cannula (HFNC) use for respiratory support in critically ill children are lacking. Therefore, we aimed to determine the risk factors for early HFNC failure to reduce the failure rate and prevent adverse consequences of HFNC failure in children with acute respiratory dysfunction.MethodsDemographic and laboratory data were compared among patients, admitted to the pediatric intensive care unit between January 2017 and December 2018, who were included in a retrospective cohort study. Univariate and multivariate analyses were performed to determine risk factors for eventual entry into the predictive model for early HFNC failure and to perform an external validation study in a prospective observational cohort study from January to February 2019. Further, the association of clinical indices and trends pre- and post-treatment with HFNC treatment success or failure in these patients was dynamically observed.ResultsIn total, 348 pediatric patients were included, of these 282 (81.0%) were included in the retrospective cohort study; HFNC success was observed in 182 patients (64.5%), HFNC 0–24 h failure in 74 patients (26.2%), and HFNC 24–48 h failure in 26 patients (9.2%). HFNC 24 h failure was significantly associated with the pediatric risk of mortality (PRISM) III score [odds ratio, 1.391; 95% confidence interval (CI): 1.249–1.550], arterial partial pressure of carbon dioxide-to-arterial partial pressure of oxygen (PaCO2/PaO2) ratio (odds ratio, 38.397; 95% CI: 6.410–230.013), and respiratory rate-oxygenation (ROX) index (odds ratio, 0.751; 95% CI: 0.616–0.915). The discriminating cutoff point for the new scoring system based on the three risk factors for HFNC 24 h failure was ≥ 2.0 points, with an area under the receiver operating characteristic curve of 0.794 (95% CI, 0.729–0.859, P < 0.001), sensitivity of 68%, and specificity of 79%; similar values were noted on applying the model to the prospective observational cohort comprising 66 patients (AUC = 0.717, 95% CI, 0.675–0.758, sensitivity 83%, specificity 44%, P = 0.009). In this prospective cohort, 11 patients with HFNC failure had an upward trend in PaCO2/PaO2 ratio and downward trends in respiratory failure index (P/F ratio) and ROX index; however, opposite directions of change were observed in 55 patients with HFNC success. Furthermore, the fractional changes (FCs) in PaCO2/PaO2 ratio, P/F ratio, percutaneous oxygen saturation-to-fraction of inspired oxygen (S/F) ratio, and ROX index at 2 h post-HFNC therapy onset were statistically significant between the two groups (all, P < 0.05).ConclusionIn the pediatric patients with acute respiratory insufficiency, pre-treatment PRISM III score, PaCO2/PaO2 ratio, and ROX index were risk factors for HFNC 24 h failure, and the direction and magnitude of changes in the PaCO2/PaO2 ratio, P/F ratio, and ROX index before and 2 h after HFNC treatment were warning indicators for HFNC 24 h failure. Further close monitoring should be considered for patients with these conditions. |
| first_indexed | 2024-04-13T18:29:57Z |
| format | Article |
| id | doaj.art-e5d49d2bbb8347fea641d518149e8481 |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-04-13T18:29:57Z |
| publishDate | 2022-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-e5d49d2bbb8347fea641d518149e84812022-12-22T02:35:08ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602022-08-011010.3389/fped.2022.979944979944Analysis of risk factors for the failure of respiratory support with high-flow nasal cannula oxygen therapy in children with acute respiratory dysfunction: A case–control studyJie Liu0Jie Liu1Deyuan Li2Deyuan Li3Lili Luo4Lili Luo5Zhongqiang Liu6Zhongqiang Liu7Xiaoqing Li8Xiaoqing Li9Lina Qiao10Lina Qiao11Department of Pediatric Intensive Care Unit, West China Second Universal Hospital, Sichuan University, Chengdu, ChinaNHC Key Laboratory of Chronobiology (Sichuan University), Ministry of Education, Chengdu, ChinaDepartment of Pediatric Intensive Care Unit, West China Second Universal Hospital, Sichuan University, Chengdu, ChinaNHC Key Laboratory of Chronobiology (Sichuan University), Ministry of Education, Chengdu, ChinaDepartment of Pediatric Intensive Care Unit, West China Second Universal Hospital, Sichuan University, Chengdu, ChinaNHC Key Laboratory of Chronobiology (Sichuan University), Ministry of Education, Chengdu, ChinaDepartment of Pediatric Intensive Care Unit, West China Second Universal Hospital, Sichuan University, Chengdu, ChinaNHC Key Laboratory of Chronobiology (Sichuan University), Ministry of Education, Chengdu, ChinaDepartment of Pediatric Intensive Care Unit, West China Second Universal Hospital, Sichuan University, Chengdu, ChinaNHC Key Laboratory of Chronobiology (Sichuan University), Ministry of Education, Chengdu, ChinaDepartment of Pediatric Intensive Care Unit, West China Second Universal Hospital, Sichuan University, Chengdu, ChinaNHC Key Laboratory of Chronobiology (Sichuan University), Ministry of Education, Chengdu, ChinaBackgroundEvidence-based clinical practice guidelines regarding high-flow nasal cannula (HFNC) use for respiratory support in critically ill children are lacking. Therefore, we aimed to determine the risk factors for early HFNC failure to reduce the failure rate and prevent adverse consequences of HFNC failure in children with acute respiratory dysfunction.MethodsDemographic and laboratory data were compared among patients, admitted to the pediatric intensive care unit between January 2017 and December 2018, who were included in a retrospective cohort study. Univariate and multivariate analyses were performed to determine risk factors for eventual entry into the predictive model for early HFNC failure and to perform an external validation study in a prospective observational cohort study from January to February 2019. Further, the association of clinical indices and trends pre- and post-treatment with HFNC treatment success or failure in these patients was dynamically observed.ResultsIn total, 348 pediatric patients were included, of these 282 (81.0%) were included in the retrospective cohort study; HFNC success was observed in 182 patients (64.5%), HFNC 0–24 h failure in 74 patients (26.2%), and HFNC 24–48 h failure in 26 patients (9.2%). HFNC 24 h failure was significantly associated with the pediatric risk of mortality (PRISM) III score [odds ratio, 1.391; 95% confidence interval (CI): 1.249–1.550], arterial partial pressure of carbon dioxide-to-arterial partial pressure of oxygen (PaCO2/PaO2) ratio (odds ratio, 38.397; 95% CI: 6.410–230.013), and respiratory rate-oxygenation (ROX) index (odds ratio, 0.751; 95% CI: 0.616–0.915). The discriminating cutoff point for the new scoring system based on the three risk factors for HFNC 24 h failure was ≥ 2.0 points, with an area under the receiver operating characteristic curve of 0.794 (95% CI, 0.729–0.859, P < 0.001), sensitivity of 68%, and specificity of 79%; similar values were noted on applying the model to the prospective observational cohort comprising 66 patients (AUC = 0.717, 95% CI, 0.675–0.758, sensitivity 83%, specificity 44%, P = 0.009). In this prospective cohort, 11 patients with HFNC failure had an upward trend in PaCO2/PaO2 ratio and downward trends in respiratory failure index (P/F ratio) and ROX index; however, opposite directions of change were observed in 55 patients with HFNC success. Furthermore, the fractional changes (FCs) in PaCO2/PaO2 ratio, P/F ratio, percutaneous oxygen saturation-to-fraction of inspired oxygen (S/F) ratio, and ROX index at 2 h post-HFNC therapy onset were statistically significant between the two groups (all, P < 0.05).ConclusionIn the pediatric patients with acute respiratory insufficiency, pre-treatment PRISM III score, PaCO2/PaO2 ratio, and ROX index were risk factors for HFNC 24 h failure, and the direction and magnitude of changes in the PaCO2/PaO2 ratio, P/F ratio, and ROX index before and 2 h after HFNC treatment were warning indicators for HFNC 24 h failure. Further close monitoring should be considered for patients with these conditions.https://www.frontiersin.org/articles/10.3389/fped.2022.979944/fullacute respiratory insufficiencyhigh-flow nasal cannula oxygen therapyrisk factorrespiratory failurepediatrics |
| spellingShingle | Jie Liu Jie Liu Deyuan Li Deyuan Li Lili Luo Lili Luo Zhongqiang Liu Zhongqiang Liu Xiaoqing Li Xiaoqing Li Lina Qiao Lina Qiao Analysis of risk factors for the failure of respiratory support with high-flow nasal cannula oxygen therapy in children with acute respiratory dysfunction: A case–control study Frontiers in Pediatrics acute respiratory insufficiency high-flow nasal cannula oxygen therapy risk factor respiratory failure pediatrics |
| title | Analysis of risk factors for the failure of respiratory support with high-flow nasal cannula oxygen therapy in children with acute respiratory dysfunction: A case–control study |
| title_full | Analysis of risk factors for the failure of respiratory support with high-flow nasal cannula oxygen therapy in children with acute respiratory dysfunction: A case–control study |
| title_fullStr | Analysis of risk factors for the failure of respiratory support with high-flow nasal cannula oxygen therapy in children with acute respiratory dysfunction: A case–control study |
| title_full_unstemmed | Analysis of risk factors for the failure of respiratory support with high-flow nasal cannula oxygen therapy in children with acute respiratory dysfunction: A case–control study |
| title_short | Analysis of risk factors for the failure of respiratory support with high-flow nasal cannula oxygen therapy in children with acute respiratory dysfunction: A case–control study |
| title_sort | analysis of risk factors for the failure of respiratory support with high flow nasal cannula oxygen therapy in children with acute respiratory dysfunction a case control study |
| topic | acute respiratory insufficiency high-flow nasal cannula oxygen therapy risk factor respiratory failure pediatrics |
| url | https://www.frontiersin.org/articles/10.3389/fped.2022.979944/full |
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