Outcome of high-flow nasal cannula (HFNC) therapy in respiratory failure due to lower respiratory tract infections in PICU - a single center experience in Karachi, Pakistan.

Objective: To evaluate the outcome of high-flow nasal cannula (HFNC) therapy by ROX index in critically ill children with acute respiratory failure due to lower respiratory tract infections in pediatric intensive care unit (PICU). Study Design: Analytical, Observational, Cross-sectional study. Setting: The PICU of the Indus Hospital, Karachi, Pakistan. Period: November 2022 to October 2023. Methods: We enrolled children of either gender, aged above 1 month up to 16 years and presenting with acute respiratory insufficiency due to lower respiratory tract infections. The use of HFNC was monitored for 72-hours. HFNC failure was characterized by requiring either noninvasive mechanical ventilation or invasive mechanical ventilation due to an unstable state. Results: In a total of 62 children, 39 (62.9%) were male. The mean age was 27.01±30.96 months. The most common diagnosis at the time of admission were pneumonia, and bronchiolitis noted in 25 (40.3%), and 33 (53.2%) children, respectively. Gradual improvement in ROX index was observed among children with HFNC success while a declining ROX index predicted HFNC failure. Outcome of HFNC was successful in 45 (72.6%) children. Mortality was observed in 12 (19.4%) children. Presence of comorbidity was significantly associated with unsuccessful HFNC outcomes. Conclusion: ROX index was found to be a good predictor of HFNC outcome. Overall, HFNC therapy in PICU demonstrated 72.6% success rate. HFNC outcomes are hampered particularly in cases involving comorbidities highlighting the need for tailored interventions.