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J Pediatr Intensive Care 2023; 12(03): 167-172
DOI: 10.1055/s-0041-1730933
Original Article

Extubation to High-Flow Nasal Cannula in Infants Following Cardiac Surgery: A Retrospective Cohort Study

Hannah Stevens
1   Faculty of Medicine, Dalhousie University, Halifax, Canada
,
Julien Gallant
2   Department of Pediatric Critical Care, IWK Health, Halifax, Canada
,
Jennifer Foster
1   Faculty of Medicine, Dalhousie University, Halifax, Canada
2   Department of Pediatric Critical Care, IWK Health, Halifax, Canada
3   Department of Critical Care, Dalhousie University, Halifax, Canada
,
David Horne
1   Faculty of Medicine, Dalhousie University, Halifax, Canada
4   Division of Pediatric Congenital Cardiac Surgery, IWK Health, Halifax, Canada
5   Department of Surgery, Dalhousie University, Halifax, Canada
,
Kristina Krmpotic 
1   Faculty of Medicine, Dalhousie University, Halifax, Canada
2   Department of Pediatric Critical Care, IWK Health, Halifax, Canada
3   Department of Critical Care, Dalhousie University, Halifax, Canada
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Abstract

High-flow nasal cannula (HFNC) therapy is commonly used in the pediatric intensive care unit (PICU) for postextubation respiratory support. This hypothesis-generating retrospective cohort study aimed to compare postextubation PICU length of stay in infants extubated to HFNC and low flow oxygen (LF) in PICU following cardiac surgery. Of 136 infants (newborn to 1 year) who were intubated and mechanically ventilated in PICU following cardiac surgery, 72 (53%) were extubated to HFNC and 64 (47%) to LF. Compared with patients extubated to LF, those extubated to HFNC had significantly longer durations of cardiopulmonary bypass (152 vs. 109 minutes; p = 0.002), aortic cross-clamp (90 vs. 63 minutes; p = 0.003), and invasive mechanical ventilation (3.2 vs. 1.6 days; p < 0.001), although demographic and preoperative clinical variables were similar. No significant difference was observed in postextubation PICU length of stay between HFNC and LF groups in unadjusted analysis (3.3 vs. 2.6 days, respectively; p = 0.19) and after controlling for potential confounding variables (F [1,125] = 0.17, p = 0.68, R2  = 0.16). Escalation of therapy was similar between HFNC and LF groups (8.3 vs. 14.1%; p = 0.41). HFNC was effective as rescue therapy for six patients in the LF group requiring escalation of therapy. Need for reintubation was similar between HFNC and LF groups (8.3 vs. 4.7%; p = 0.5). Although extubation to HFNC was associated with a trend toward longer postextubation PICU length of stay and was successfully used as rescue therapy for several infants extubated to LF, our results must be interpreted with caution given the limitations of our study.

Keywords

extubation - high-flow nasal cannula - mechanical ventilation - noninvasive ventilation - pediatric cardiac surgery - pediatric intensive care unit


Publication History

Received: 14 December 2020

Accepted: 21 April 2021

Article published online:
19 June 2021

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