High flow nasal canula (HFNC) for respiratory support in RCU department of Raparin Teaching Hospital for Children

Abstract

Background and Objectives: High-flow nasal cannula (HFNC) has emerged as a promising non-invasive respiratory support for children with acute respiratory distress. This study evaluated the effectiveness of HFNC and identified predictors of therapy outcomes in pediatric patients admitted to the Respiratory Care Unit (RCU) of Raparin Teaching Hospital for Children. 

Methods: This retrospective observational study included 120 pediatric patients (mean age 37.08 ± 29.76 months) admitted between January 2022 and December 2024. Clinical, demographic, and laboratory data were collected at baseline, 8 hours, and 48 hours after HFNC initiation. Outcomes were classified as success (weaning from HFNC) or failure (escalation to mechanical ventilation). 

Results: HFNC was successful in 103 (85.8%) patients and failed in 17 (14.2%). Infants aged <12 months had the highest failure rate (19; 61.3%), compared with 1–5 years (15; 25.4%) and >5 years (2; 6.7%) (P = 0.002). Chronic disease strongly predicted failure (16/41; 39.0%) versus those without comorbidities (1/79; 1.3%) (P <0.001). FiO₂ >60% was uniformly associated with failure (7; 100%) (P <0.001). Air leak syndrome occurred only in failure cases (9; 100%). Vital signs and blood gases improved significantly in successes, including reduction in respiratory rate (58.47 ± 6.40 to 40.40 ± 3.29/min) and improved oxygen saturation (88.58 ± 2.64% to 97.32 ± 0.96%) (all P <0.001). 

Conclusion: HFNC therapy demonstrates high efficacy in pediatric respiratory support with predictable success patterns. Age, comorbidity status, FiO₂ requirements, and air leak development serve as reliable predictors for treatment outcomes, facilitating evidence-based clinical decision-making in resource-limited settings.