HIGH FLOW NASAL CANNULA AND UNFAVORABLE CLINICAL OUTCOMES IN PEDIATRIC ACUTE RESPIRATORY FAILURE IN AN EMERGENCY SERVICE IN LIMA, PERU, 2020-2023

Abstract

Introduction: High-flow nasal cannula (HFNC) oxygen therapy has emerged as a novel method of oxygen delivery. This study aims to determine the association between HFNC use and reduced endotracheal intubation, pediatric intensive care unit (PICU) admission, and mortality among children with acute respiratory failure treated in a pediatric emergency department in Lima, Peru, 2020–2023. Methodology: Retrospective cohort study analyzing medical records of patients aged 1 month to 14 years who presented to the pediatric emergency department with a diagnosis of respiratory distress, during the pre-HFNC period (June 2019– July 2020) and the HFNC period (January 2023–December 2023). Results: A total of 262 medical records were analyzed (131 per cohort). Thirteen children (9.92%) required endotracheal intubation in the HFNC cohort, compared with 39 children (29.77%) in the conventional oxygen therapy cohort. HFNC use was associated with a lower risk of intubation (RR = 0.40; 95% CI 0.22–0.71; p=0.002) and a lower risk of mortality (adjusted RR = 0.20; 95% CI 0.06–0.61; p=0.005), after adjustment for sex, age, comorbidity, and respiratory distress severity. No association was observed with reduced ICU admission. Conclusions: The use of HFNC in children with moderate-to-severe respiratory distress reduces the need for endotracheal intubation and mortality.