HFNC vs. COT in PICU
Trial question
What is the effect of high-flow nasal cannula oxygen therapy for extubation failure prevention in children admitted to the pediatric ICU?
Study design
Single center
Open label
RCT
Population
Characteristics of study participants
40.0% female
60.0% male
N = 102
102 patients (41 female, 61 male).
Inclusion criteria: patients, aged between 1 month and 18 years, admitted to the pediatric ICU who were mechanically ventilated for > 12 hours.
Key exclusion criteria: tracheostomy; diaphragm paralysis; patients for whom attending consultant's choice of postextubation respiratory support is predetermined.
Interventions
N=51 high-flow nasal cannula (FiO2 of 60% with graded titration and flow rate of 2 L/kg/min for the first 10 kg body weight, then 0.5 L/kg/min for body weight exceeding 10 kg, up to a maximum of 50 L/min).
N=51 conventional oxygen therapy (oxygen flow rate of 2-4 L/min for nasal prongs, 6-10 L/min for face mask, and 10-15 L/min for nonrebreathing facemasks).
Primary outcome
Reintubation
23.5%
29.4%
29.4 %
22.0 %
14.7 %
7.3 %
0.0 %
High-flow nasal
cannula
Conventional oxygen
therapy
No significant
difference ↔
No significant difference in reintubation (23.5% vs. 29.4%; RR 0.8, 95% CI -1.47 to 3.07).
Secondary outcomes
No significant difference in mean pediatric ICU stay (7.2 days vs. 6.53 days; MD 0.67, 95% CI -0.97 to 2.31).
Borderline significant increase in death (7.8% vs. 5.9%).
Conclusion
In patients, aged between 1 month and 18 years, admitted to the pediatric ICU who were mechanically ventilated for > 12 hours, high-flow nasal cannula was not superior to conventional oxygen therapy with respect to reintubation.
Reference
Panda, Priyabrata, Sagar et al. Comparison of the effectiveness of high-flow nasal cannula oxygen therapy versus conventional oxygen therapy in preventing extubation failure in children admitted to pediatric intensive care unit in a tertiary care hospital: An open-label randomized control trial. Journal of Pediatric Critical Care 12(2):p 45-51, Mar–Apr 2025.
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