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
