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DOI: 10.1016/j.medine.2021.02.002
Available online 26 February 2021
Factors associated to high-flow nasal cannula treatment failure in pediatric patients with respiratory failure in two pediatric intensive care units at high altitude
Factores asociados al fracaso de la terapia con cánulas nasales de alto flujo en pacientes pediátricos con insuficiencia respiratoria en dos unidades de cuidados críticos pediátricos a gran altitud
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P. Vásquez-Hoyosa,b,c,
Corresponding author
pvasquez@fucsalud.edu.co

Corresponding author.
, A. Jiménez-Chavesd, M. Tovar-Velásqueza,c, R. Albor-Ortegaa, M. Palenciaa,c, D. Redondo-Pastranaa,c, P. Díaza, J.D. Roa-Giraldoa,c
a Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
b Universidad Nacional de Colombia, Bogotá, Colombia
c Hospital de San José de Bogotá, Bogotá, Colombia
d Clínica Infantil Colsubsidio, Bogotá, Colombia
Received 02 July 2019. Accepted 18 October 2019
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Figures (2)
Tables (4)
Table 1. Demographic and diagnostic description and outcomes of patients on high-flow nasal cannula therapy.
Table 2. Well-being follow-up within the first 24h of follow-up in patients on high-flow nasal cannula therapy.
Table 3. Bivariate analysis comparing the study variables to the different types of therapy failure in patients on high-flow nasal cannula therapy.
Table 4. Multivariate model comparing significant variables based on the different types of therapy failure in patients on high-flow nasal cannula therapy.
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Abstract
Introduction

Acute respiratory failure is the leading cause of hospitalization in pediatrics. High-flow nasal cannulas (HFNCs) offer a new alternative, but the evidence and indications are still debated. The performance of HFNCs at high altitude has not been described to date.

Objective

To describe the use of HFNCs in pediatric patients admitted with respiratory failure and explore the factors associated with treatment failure.

Methodology

A prospective cohort study was carried out in patients between 1 month and 18 years of age managed with HFNCs. The demographic and treatment response data were recorded at baseline and after 1, 6 and 24h. The number of failures was determined, as well as the length of stay, complications and mortality. Patients with treatment failure were compared with the rest.

Results

A total of 539 patients were enrolled. Infants (70.9%) of male sex (58.4%) and airway diseases such as asthma and bronchiolitis (61.2%) were more frequent. There were 53 failures (9.8%), with 21 occurring in the first 24h. The median length of stay was 4 days (IQR 4); there were 5 deaths (0.9%) and 13 adverse events (epistaxis) (2.2%). Improvement was observed in vital signs and severity over time, with differences in the group that failed, but without interactions. The final logistic model established an independent relationship of failure between the hospital (OR 2.78, 95%CI 1.48–5.21) and the initial respiratory rate (OR 1.56, 95%CI 1.21–2.01).

Conclusions

HFNCs afford good clinical response, with few complications and a low failure rate. The differences found between institutions suggest a subjective relationship in the decision of therapy failure.

Keywords:
Oxygen inhalation therapy
Non invasive ventilation
Intensive Care Unit Pediatric
Respiratory failure
Altitude
Resumen
Introducción

El fallo respiratorio agudo es la principal causa de hospitalización en pediatría. Las cánulas nasales de alto flujo (CNAF) ofrecen una nueva alternativa, pero sigue existiendo debate en torno a la evidencia e indicaciones. No se ha descrito su comportamiento en gran altitud.

Objetivo

Describir el uso de CNAF en pacientes pediátricos que ingresan con insuficiencia respiratoria y explorar los factores asociados al fracaso de la terapia.

Metodología

Estudio de cohortes prospectivo. Pacientes entre un mes y 18 años manejados con CNAF. Se describieron datos demográficos y se evaluó la respuesta al inicio, 1.a, 6.a y 24.a horas. Se determinó el número de fracasos, así como estancia, complicaciones y mortalidad. Se compararon los pacientes con fracaso al tratamiento.

Resultados

Ingresaron 539 pacientes. Fueron más frecuentes los lactantes (70,9%) de sexo masculino (58,4%) con afecciones respiratorias como asma y bronquiolitis (61,2%). Se presentaron 53 fracasos (9,8%), 21 en las primeras 24 horas. La mediana de estancia fue de 4 días (RIQ 4), hubo 5 éxitus (0,9%) y 13 eventos adversos –epistaxis– (2,2%). Se observó mejoría de signos vitales y gravedad en el tiempo con diferencias en el grupo que fracasó, pero sin interacciones. El modelo logístico final estimó una relación independiente del fracaso, entre el hospital (OR 2,78; IC95% 1,48-5,21) y la frecuencia respiratoria inicial (OR 1,56; IC95% 1,21-2,01).

Conclusión

La CNAF es un sistema con buena respuesta clínica, pocas complicaciones y una baja tasa de fracasos. Las diferencias entre las instituciones sugieren una relación subjetiva de la decisión del fracaso.

Palabras clave:
Terapia por inhalación de oxígeno
Ventilación no invasiva
Unidades de Cuidados Intensivos Pediátricos
Insuficiencia respiratoria
Altitud

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