Use of High-Flow Nasal Cannula Therapy in Pediatric Hematology/Oncology Patients Admitted to the Pediatric Intensive Care Unit with Acute Respiratory Failure

Background
High-flow nasal cannula (HFNC) therapy is an essential tool for managing acute respiratory failure (ARF) in pediatric patients with hematological and oncological conditions. This study aimed to evaluate the HFNC failure rate and identify factors associated with HFNC failure in pediatric hematology/oncology patients admitted to the pediatric intensive care unit (PICU) with ARF.


Methods
This is a retrospective cohort study that included 200 pediatric hematology/oncology patients aged 0–14 years with ARF who underwent HFNC. All patients were admitted to the PICU at the King Fahad National Center for Child Cancer in Saudi Arabia from January 2018 to December 2020.


Results
The patient cohort had a median age of 3 years (interquartile range [IQR]: 1.3–7.0), and (61.5%) of patients were males. The key indications for HFNC were pneumonia (48.0%), sepsis (46.0%), and cardiac failure (18.0%). The median duration of HFNC was 36 h (IQR: 20–68), and the median PICU length of stay was 6 days (IQR: 4–16). HFNC failure rate was (27.0%). Air leaks were reported in (2.5%) of patients. The PICU mortality was 29.5% (59/200), including 40 patients (67.8%) with HFNC failure. Required intubation within 48 h was observed in 13.0% (26/200) of patients. Multivariable analysis revealed that the initial pH (p = 0.030), shorter HFNC duration (p < 0.001), cardiac failure (p = 0.009), and sepsis (p = 0.041) were predictors of HFNC failure.


Conclusion
The HFNC failure rate in this study was 27%, which is within the range of other studies. Thus, HFNC is an acceptable treatment option for pediatric hematology/oncology patients with ARF. However, further investigation is required.