LAUSR

Learning Objectives: Non-invasive ventilation (NIV) using heated humidified high flow nasal cannula (HFNC) is traditionally applied to young children and infants with acute viral bronchiolitis or neonatal respiratory distress syndrome. Limited data exists to support HFNC in other populations. However, an increasing number of providers apply HFNC in other diseases such as status asthmaticus (SA). We seek to describe our experience with HFNC in children with SA in our pediatric intensive care unit (PICU). Methods: We retrospectively reviewed charts of children 5-18 years of age admitted to our PICU for SA from May 2015-May 2018 to identify cases placed on HFNC. Primary outcomes were demographics, anthropometrics, respiratory therapies, medications, severity of illness metrics, length of stay (LOS), and HFNC-failure (mechanical ventilation or conversion to alternative NIV). Statistics were descriptive including frequencies, means ± standard deviation, and medians (interquartile range). Of the 210 children with SA admitted to the PICU during the study period, 15 cases (7%) received HFNC. Initiation of HFNC occurred at a median of 9.4 (0.2-33) hours after admission and maintained for 17 (8-30) hours. Mean age was 6.7 ± 2.1 years, weight 27.4 ± 7.6 kilograms, Pediatric Index of Mortality-3 risk of mortality 0.24%±0.03, Pediatric Risk of Mortality-3 probability of death 0.75%±1.13, and admission Pediatric Asthma Severity Score (PASS) 10.1 ± 2.3. Preadmission National Heart Lung and Brain Institute severity categories of moderate and severe persistent asthma were noted in 73% of cases. Mean PICU LOS was 1.8 ± 1.3 days and hospital LOS 4.2 ± 2.8 days. Comorbid bacterial pneumonia (60%) and respiratory viral infection (47%) were common. Additional therapies included continuous albuterol via HFNC (n=10 for a mean of 21.9 ± 14 hours), terbutaline (n=1 for 5 hours), magnesium sulfate (n=12, isolated bolus), and helium via HFNC (n=1 for 21 hours). We observed no HFNC-failure, extracorporeal membrane oxygenation, or in-hospital mortality. Results: Over a 3-year period, few children (7%) with SA were placed on HFNC in our institution. A majority (80%) had concurrent bacterial pneumonia or viral respiratory infection. Helium (7%) and nebulized albuterol (67%) were administered inline with HFNC during NIV support. While HFNC appears well tolerated in our case series, further data regarding safety, efficacy, and effectiveness as a medication delivery modality are required prior to adoption of routine HFNC use for SA.