Comparison of high flow oxygen therapy versus noninvasive mechanical ventilation for successful weaning from invasive ventilation in children: An observational study

Abstract

Post-extubation respiratory failure is associated with a poor prognosis due to increased ventilator-associated pneumonia, and longer length of stay in the ICU and hospital. In this study, we aimed to evaluate the efficacy of high-flow nasal cannula (HFNC) and noninvasive mechanical ventilation (NIMV) on extubation success in children. A total of 48 patients, aged between 1 month and 18 years, who were weaned to either NIMV or HFNC were included. Patients who had tracheostomy or were not weaned and underwent unplanned extubation were excluded. Age, gender, anthropometric parameters, Pediatric Risk of Mortality and Pediatric Logistic Organ Dysfunction scores, oxygenation index, mechanical ventilation length of stay (LOS), HFNC/NIMV LOS, Modified Downes-Silverman score (MDS), and venous blood gas parameters, pediatric intensive care unit (PICU) LOS were recorded. 24 patients were extubated to NIMV, and 24 patients to HFNC. HFNC LOS and NIMV LOS were similar ( P = .621). The failure rates at the 48th hour of HFNC and NIMV were 33% (n = 8), and 33% respectively (n = 8) ( P = 1.0). PICU LOS and mortality rate was also similar ( P = .06, P = .312 respectively). MDS decreased significantly in both groups ( P < .001, P = .02 respectively). Changes in blood gas parameters and MDS within the first 48-hour of device application were similar between the 2 groups. HFNC is not inferior to NIMV in patients with extubation difficulty or those expected to have such difficulty in terms of treatment success, PICU LOS, and mortality. Therefore, HFNC appears to be a weaning technique alternative to NIMV after extubation.

Critical Case of a Preterm Infant Infected With Respiratory Syncytial Virus Managed in the Pediatric Intensive Care Unit: A Case Report

“…Following this phase of intensive treatment, the medical team successfully weaned the patient from HFOV to a conventional ventilator over three days, culminating in a successful extubation. After extubation, the patient was managed with alternating HFNC therapy and NIPPV [7]. In addition to frequent respiratory care, including bronchodilators, suctioning, and chest physiotherapy, after one week of recovery, the infant was discharged home in a stable condition.…”

“…During the recovery phase following extubation, the patient was alternately treated with high-flow nasal cannula (HFNC) therapy and non-invasive positive pressure ventilation (NIPPV) [7], along with continuous respiratory care including bronchodilators, suctioning, and chest physiotherapy. After one week of this treatment, a chest X-ray was repeated and showed bilateral normal lungs, as shown in Figure 4.…”

Predictores de fracaso de oxigenoterapia por catéter nasal de alto flujo en menores de 2 años con infecciones respiratorias agudas bajas

“…En esta serie, no se analizó la frecuencia cardíaca previo a la conexión, y las alteraciones radiológicas (opacidad in-homogénea, atelectasia, neumotórax, cisuritis) fueron analizadas en forma global y dicotómica, y no alcanzaron significación estadística. Es bien conocido que la presencia de neumonía es un factor predictor de fracaso de esta terapia, por lo que sería importante incluir estos aspectos en futuras investigaciones 24 .…”