title: The Clinical Impact of Heated Humidified High-Flow Nasal Cannula on Pediatric Respiratory Distress.
abstract: To assess the impact on a single PICU of introducing high-flow nasal cannula as a management tool for respiratory distress.
  
  
  
  Retrospective cohort study, including an interrupted time series analysis with a propensity score adjustment and a matched-pair analysis.
  
  
  
  A single university-affiliated children's hospital PICU.
  
  
  
  None.
  
  
  
  Differences in clinical outcomes when comparing the pre-high-flow nasal cannula era (2004-2008) and the high-flow nasal cannula era (2010-2014), excluding 2009 as a washout period, and clinical impacts of high-flow nasal cannula as an exposure of interest. A total of 1,766 children met the inclusion criteria (pre-high-flow nasal cannula era: 699 patients; high-flow nasal cannula era: 1,067 patients). High-flow nasal cannula was used in 455 patients (42.6%) in the high-flow nasal cannula era. The interrupted time series analysis failed to show a statistically significant difference in PICU length of stay, but the duration of invasive ventilation was shortened by an average of 2.3 days in the high-flow nasal cannula era group (95% CI, 0.2-4.4; p = 0.030). The PICU intubation rate in the high-flow nasal cannula era was 0.72 times that of the pre-high-flow nasal cannula era (95% CI, 0.63-0.84; p < 0.001). A total of 373 pairs were formed for the matched-pair analysis. The odds for being intubated in the PICU for those patients using high-flow nasal cannula was 0.06 (95% CI, 0.02-0.16; p < 0.001) when compared with those who did not use high-flow nasal cannula. The PICU length of stay increased by 2.9 days in those patients in which high-flow nasal cannula was used (95% CI, 1.3-4.4; p < 0.001).
  
  
  
  The introduction of high-flow nasal cannula as a therapy for respiratory distress in the PICU was associated with a significant decrease in the PICU intubation rate with no associated change in mortality.
authors.affiliation: 1Department of Pediatrics, Pediatric Critical Care Medicine, University of Alberta, Edmonton, AB. 2School of Public Health, University of Alberta, Edmonton, AB.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kawaguchi
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yasui
authors.forename: Allan
authors.initials: A
authors.lastname: deCaen
authors.forename: Daniel
authors.initials: D
authors.lastname: Garros
mesh_terms: D000293:Adolescent; D000072601:Cannula; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D016555:Matched-Pair Analysis; D010102:Oxygen Inhalation Therapy / Q000295:instrumentation* / Q000379:methods; D057216:Propensity Score; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012131:Respiratory Insufficiency / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome