PT - JOURNAL ARTICLE AU - Rachel M Gates AU - Kaitlyn E Haynes AU - Kyle J Rehder AU - Kanecia O Zimmerman AU - Alexandre T Rotta AU - Andrew G Miller TI - High-Flow Nasal Cannula in Pediatric Critical Asthma AID - 10.4187/respcare.08740 DP - 2021 Aug 01 TA - Respiratory Care PG - 1240--1246 VI - 66 IP - 8 4099 - http://rc.rcjournal.com/content/66/8/1240.short 4100 - http://rc.rcjournal.com/content/66/8/1240.full AB - BACKGROUND: High-flow nasal cannula (HFNC) has been used in the treatment of pediatric asthma, although high-quality data comparing HFNC to aerosol mask nebulizer are lacking. We hypothesized that HFNC would perform similarly to the aerosol mask for meaningful clinical outcomes in children with critical asthma.METHODS: We retrospectively reviewed the medical records of children with critical asthma (age 2–17 y) with a modified pulmonary index score (MPIS) ≥ 8 admitted to our pediatric ICU as part of a quality improvement project. Patients were managed with our MPIS-based, respiratory therapist-driven protocol. Subjects were divided into 2 cohorts by initial respiratory support: HFNC or aerosol mask. Data included demographics, initial respiratory support, and MPIS over time. Primary outcome was hospital length of stay (LOS). Secondary outcome was difference in MPIS over time.RESULTS: We included 171 subjects, with 104 in the HFNC group and 67 in the aerosol mask group. Median (interquartile range [IQR]) age was lower in the HFNC group (5 [IQR 4–9] vs 7 [IQR 5–10] y, P = .006)], while other demographic characteristics were similar. Initial MPIS was similar between HFNC and aerosol mask groups (11 [IQR 9–12] vs 10 [IQR 9–12], P = .15). There were no significant differences for hospital LOS (2.9 [IQR 2.1–3.9] vs 3.0 [IQR 2.3–4.4] d, P = .47), pediatric ICU LOS (1.9 [IQR 1.4–2.8] vs 1.8 [IQR 1.5–3.0] d, P = .92), or time to MPIS < 6 (1.0 [IQR 0.6–1.6] vs 1.3 [IQR 0.8–1.9) d, P = .09) between the HFNC and aerosol mask groups, respectively. Median time on continuous albuterol was shorter in the HFNC group compared to the aerosol mask group (1.0 [IQR 0.7–1.8] vs 1.5 [IQR 0.9–2.3] d, P = .048). Of note, 16 (24%) subjects in the aerosol mask group were eventually treated with HFNC. Use of a helium-oxygen mixture and noninvasive ventilation was similar between groups.CONCLUSIONS: HFNC performed similarly to aerosol mask in pediatric patients with critical asthma.