title: [High flow nasal cannula in infants: Experience in a critical patient unit].
abstract: BACKGROUND
  The high flow nasal cannula (HFNC) is a method of respiratory support that is increasingly being used in paediatrics due to its results and safety.
  
  
  OBJECTIVE
  To determine the efficacy of HFNC, as well as to evaluate the factors related to its failure and complications associated with its use in infants.
  
  
  METHODS
  An analysis was performed on the demographic, clinical, blood gas, and radiological data, as well as the complications of patients connected to a HFNC in a critical care unit between June 2012 and September 2014. A comparison was made between the patients who failed and those who responded to HFNC. A failure was considered as the need for further respiratory support during the first 48hours of connection. The Kolmogorov Smirnov, Mann-Whitney U, chi squared and the Exact Fisher test were used, as well as correlations and a binary logistic regression model for P≤.05.
  
  
  RESULTS
  The study included 109 patients, with a median age and weight: 1 month (0.2-20 months) and 3.7kg (2-10kg); 95 percentile: 3.7 months and 5.7kg, respectively. The most frequent diagnosis and radiological pattern was bronchiolitis (53.2%) and interstitial infiltration (56%). Around 70.6% responded. There was a significant difference between failure and response in the diagnosis (P=.013), radiography (P=018), connection context (P<.0001), pCO2 (median 40.7mmHg [15.4-67 mmHg] versus 47.3mmHg [28.6-71.3mmHg], P=.004) and hours on HFNC (median 60.75hrs [5-621.5 hrs] versus 10.5hrs [1-29 hrs], P<.0001). The OR of the PCO2 ≥ 55mmHg for failure was 2.97 (95% CI; 1.08-8.17; P=.035). No patient died and no complications were recorded.
  
  
  CONCLUSIONS
  The percentage success observed was similar to that published. In this sample, the failure of HFNC was only associated with an initial pCO2 ≥ 55mmHg. On there being no complications reported as regards it use, it is considered safe, although a randomised, controlled, multicentre study is required to compare and contrast these results.
authors.affiliation: Pediatra Intensivista, Unidad de Paciente Crítico Pediátrico (UPCP), Complejo Asistencial Dr. Sotero del Río, Santiago, Chile. Electronic address: awegnera@gmail.com.
authors.forename: Adriana
authors.initials: A
authors.lastname: Wegner A
authors.affiliation: Pediatra Intensivista, Unidad de Paciente Crítico Pediátrico (UPCP), Complejo Asistencial Dr. Sotero del Río, Santiago, Chile.
authors.forename: Pamela
authors.initials: P
authors.lastname: Cespedes F
authors.affiliation: Pediatra Intensivista, Unidad de Paciente Crítico Pediátrico (UPCP), Complejo Asistencial Dr. Sotero del Río, Santiago, Chile.
authors.forename: María Loreto
authors.initials: ML
authors.lastname: Godoy M
authors.affiliation: Pediatra Intensivista, Unidad de Paciente Crítico Pediátrico (UPCP), Complejo Asistencial Dr. Sotero del Río, Santiago, Chile.
authors.forename: Pedro
authors.initials: P
authors.lastname: Erices B
authors.affiliation: Pediatra Intensivista, Unidad de Paciente Crítico Pediátrico (UPCP), Complejo Asistencial Dr. Sotero del Río, Santiago, Chile.
authors.forename: Luis
authors.initials: L
authors.lastname: Urrutia C
authors.affiliation: Pediatra, UPCP Complejo Asistencial Dr. Sotero del Río, Santiago, Chile.
authors.forename: Carina
authors.initials: C
authors.lastname: Venthur U
authors.affiliation: Pediatra, UPCP Complejo Asistencial Dr. Sotero del Río, Santiago, Chile.
authors.forename: Marcela
authors.initials: M
authors.lastname: Labbé C
authors.affiliation: Terapista Respiratorio, UPCP Complejo Asistencial Dr. Sotero del Río, Santiago, Chile.
authors.forename: Hugo
authors.initials: H
authors.lastname: Riquelme M
authors.affiliation: Enfermera, UPCP Complejo Asistencial Dr. Sotero del Río, Santiago, Chile.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Sanchez J
authors.affiliation: Terapista Respiratorio, UPCP Complejo Asistencial Dr. Sotero del Río, Santiago, Chile.
authors.forename: Waldo
authors.initials: W
authors.lastname: Vera V
authors.affiliation: Terapista Respiratorio, UPCP Complejo Asistencial Dr. Sotero del Río, Santiago, Chile.
authors.forename: David
authors.initials: D
authors.lastname: Wood V
authors.affiliation: Terapista Respiratorio, UPCP Complejo Asistencial Dr. Sotero del Río, Santiago, Chile.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Contreras C
authors.affiliation: Terapista Respiratorio, UPCP Complejo Asistencial Dr. Sotero del Río, Santiago, Chile.
authors.forename: Efren
authors.initials: E
authors.lastname: Urrutia S
mesh_terms: D000281:Administration, Intranasal; D001784:Blood Gas Analysis; D001988:Bronchiolitis / Q000453:epidemiology / Q000628:therapy; D002245:Carbon Dioxide / Q000097:blood; D002404:Catheterization / Q000379:methods*; D003422:Critical Care / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D016015:Logistic Models; D008137:Longitudinal Studies; D008171:Lung Diseases / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D017563:Lung Diseases, Interstitial / Q000453:epidemiology / Q000628:therapy; D008297:Male; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D002245:Carbon Dioxide
keywords: Acute respiratory failure; Cánula nasal de alto flujo; Falla respiratoria aguda; High flow nasal cannula; Infants; Lactantes; Oxigenoterapia; Oxygen therapy