High flow nasal cannula versus non-invasive ventilation in
severe asthma: two years prospective observational study.
Carolina Solé Delgado1, Alberto García-Salido MD,
PhD2, Ainhoa Gochi Valdovinos1,
Anthony González Brabin1, María Ángeles García-Teresa
MD1, Amelia Martínez de Azagra-Garde
MD1, Inés Leoz-Gordillo MD1, María
Isabel Iglesias-Bouzas MD1, Marta Cabrero-Hernández
MD1, José Luis Unzueta-Roch MD1,
Gema De Lama Caro-Patón MD1, Montserrat Nieto-Moro
MD1
1Pediatric Critical Care Unit, Hospital Infantil
Universitario Niño Jesús, Madrid, Spain.
2Corresponding author : Alberto García-Salido,
MD, PhD, Pediatric Intensive Care Unit. Hospital Infantil Universitario
Niño Jesús. Avenida Menéndez Pelayo 65, Madrid, Spain. +34 915035900.
https://orcid.org/0000-0002-8038-7430 Email;citopensis@yahoo.es.
No funding.
The authors have disclosed that they do not have any potential conflicts
of interest.
Keywords : asthma, pediatric critical care, children, high flow
nasal cannula, non-invasive ventilation
Background : in recent years, High Flow Nasal Cannula (HFNC) has
been considered an alternative to non-invasive mechanical ventilation
(NIMV) in severe asthma respiratory management in children.
Objective : to describe the use of HFNC in children with severe
asthma admitted to pediatric critical care unit (PICU). To compare its
clinical characteristic and evolution with those receiving NIMV or other
respiratory support.
Methods : prospective observational study done in children
admitted to PICU with severe asthma (October 2017 to October 2019). Data
collected: epidemiological, clinical, respiratory support, thorax x-ray,
pharmacological treatments and days of admission. Patients were divided
into groups: 1) Only HFNC 2) HFNC and NIMV, and 3) Only NIMV.
Results : Seventy-six patients included, 39 girls. The median
age was two years and one month (range 160). The median pulmonary score
was 5 (range 7). PICU admission lengths a median of 3 days (range 9),
hospital 6 days (range 23). There were no epidemiological or clinical
differences between groups. Children with only HNFC showed a shorter
time of PICU days (p 0,025) and none of them required NIMV. In the group
receiving both modalities, NIMV was used first and then HFNC in all
cases. Children with HFNC showed higher
SaO2/FiO2 ratio (p=0,025) and lower
PCO2 level (p=0,032). There were no deaths.
Conclusions: in our study the HFNC did not require escalation
to NIMV and did not increase the length of PICU or hospital days. Normal
initial blood gases and absence of high oxygen requirements were useful
to select responders to HNFC.