title: Use of high-flow nasal cannula support in the emergency department reduces the need for intubation in pediatric acute respiratory insufficiency.
abstract: OBJECTIVE
  The objective of this study was to determine whether the use of heated, humidified, high-flow nasal cannula (HFNC) therapy is associated with a decreased need for intubation in patients presenting to a pediatric emergency department (PED) and admitted to a pediatric intensive care unit (PICU) with acute respiratory insufficiency (ARI).
  
  
  METHODS
  A retrospective study of all patients admitted from the PED to the PICU with ARI from January 2006 through December 2009. Patients admitted before the availability of HFNC (cohort 1) were compared with those admitted after the availability of HFNC but before implementation of an institution-wide guideline on pediatric HFNC usage (cohort 2) and those admitted after the implementation of a pediatric HFNC usage guideline (cohort 3).
  
  
  RESULTS
  After controlling for age, month of admission, type of respiratory illness, and severity of illness, there was an 83% reduction in the odds of intubation in the PED in cohort 3 compared with cohort 1 (odds ratio, 0.17; 95% confidence interval, 0.06-0.50; P = 0.001). There was no significant change in mortality or median PICU length of stay after the introduction of HFNC.
  
  
  CONCLUSIONS
  High-flow nasal cannula used early in the development of pediatric ARI is associated with a decreased the need for intubation and mechanical ventilation.
authors.affiliation: Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, USA. Robyn.Wing2@umassmemorial.org
authors.forename: Robyn
authors.initials: R
authors.lastname: Wing
authors.forename: Catherine
authors.initials: C
authors.lastname: James
authors.forename: Louise S
authors.initials: LS
authors.lastname: Maranda
authors.forename: Carrie C
authors.initials: CC
authors.lastname: Armsby
mesh_terms: D000208:Acute Disease; D057785:Catheters / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D017052:Hospital Mortality; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012131:Respiratory Insufficiency / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome