The Clinical Impact of Heated Humidified High-Flow Nasal Cannula on Pediatric Respiratory Distress

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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.



Measurements and Main Results:

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.

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