title: High-flow nasal cannula therapy versus non-invasive ventilation in children with severe acute asthma exacerbation: An observational cohort study.
abstract: BACKGROUND
  The present study describes our experience with the high-flow humidified nasal cannula (HFNC) versus non-invasive ventilation (NIV) in children with severe acute asthma exacerbation (SA).
  
  
  METHODS
  An observational study of a retrospective cohort of 42 children with SA admitted to a Pediatric Intensive Care Unit (PICU) for non-invasive respiratory support was made. The primary outcome measure was failure of initial respiratory support (need to escalate from HFNC to NIV or from NIV to invasive ventilation). Secondary outcome measures were the duration of respiratory support and PICU length of stay (LOS).
  
  
  RESULTS
  Forty-two children met the inclusion criteria. Twenty (47.6%) received HFNC and 22 (52.3%) NIV as initial respiratory support. There were no treatment failures in the NIV group. However, 8 children (40%) in the HFNC group required escalation to NIV. The PICU LOS was similar in both the NIV and HFNC groups. However, on considering the HFNC failure subgroup, the median length of respiratory support was 3-fold longer (63h) and the PICU LOS was also longer compared with the rest of subjects exhibiting treatment success.
  
  
  CONCLUSIONS
  Despite its obvious limitations, this observational study could suggest that HFNC in some subjects with SA may delay NIV support and potentially cause longer respiratory support, and longer PICU LOS.
authors.affiliation: PICU, Cruces University Hospital, Plaza de Cruces s/n, Barakaldo 48903, Spain. Electronic address: fco.javier.pilarorive@osakidetza.eus.
authors.forename: J
authors.initials: J
authors.lastname: Pilar
authors.affiliation: PICU, Hospital Universitari i Politècnic La Fe de Valencia, Avinguda de Fernando Abril Martorell, 106, 46026 Valencia, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Modesto I Alapont
authors.affiliation: PICU, Cruces University Hospital, Plaza de Cruces s/n, Barakaldo 48903, Spain.
authors.forename: Y M
authors.initials: YM
authors.lastname: Lopez-Fernandez
authors.affiliation: PICU, Cruces University Hospital, Plaza de Cruces s/n, Barakaldo 48903, Spain.
authors.forename: O
authors.initials: O
authors.lastname: Lopez-Macias
authors.affiliation: PICU, Cruces University Hospital, Plaza de Cruces s/n, Barakaldo 48903, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Garcia-Urabayen
authors.affiliation: PICU, Cruces University Hospital, Plaza de Cruces s/n, Barakaldo 48903, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Amores-Hernandez
mesh_terms: D000293:Adolescent; D000072601:Cannula; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D008297:Male; D063087:Noninvasive Ventilation / Q000379:methods*; D010102:Oxygen Inhalation Therapy / Q000295:instrumentation / Q000379:methods*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013224:Status Asthmaticus / Q000188:drug therapy / Q000628:therapy*; D062606:Tertiary Care Centers; D016896:Treatment Outcome
keywords: Asthma exacerbation; Children; Critical care; Cuidados críticos; Duración de la estancia; Estatus asmático; High-flow nasal cannula; Length of stay; Niños; Non-invasive ventilation; Oxigenoterapia de alto flujo; Ventilación no invasiva