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The use of heated, humidified, high-flow nasal cannula (HFNC) has grown substantially in pediatric practice over the past decade.1 Whereas historically used for infants with critical viral bronchiolitis, its use has expanded to a wide range of pediatric age groups, settings, and diagnostic conditions.2,3 Whereas there are many proposed mechanisms to its therapeutic effectiveness, the widespread increase in use presents many challenges to providers in the pediatric ICU (PICU). These challenges include patient selection and device management strategies. Do all patients with respiratory distress benefit from HFNC therapy? Do only certain diagnostic populations or age groups? When is the optimal time to start HFNC therapy, and how do you objectively assess its efficacy? In this issue of Respiratory Care, Webb et al explore the final proposed question regarding how to objectively measure if treatment with HFNC is improving a patient’s clinical condition and how to predict which patients are likely to fail HFNC treatment.4
Current practice in the PICU regarding HFNC use varies widely by institution and provider.5 Ongoing assessment regarding the effectiveness of HFNC in a particular patient involves individual providers performing clinical assessments and using subjective metrics to determine which patients are improving and which are likely to need more invasive forms of respiratory support. In this novel study, Webb et al4 applied 2 objective, standardized scoring systems, the ratio of oxygen saturation (ROX) and ROX-heart rate (ROX-HR) indices, previously validated in adult patients, to predict which pediatric subjects would fail HFNC therapy. HFNC treatment failure was defined as the need for noninvasive ventilation or …
Correspondence: Colin M Rogerson MD MPH, Assistant Professor of Pediatrics, Division of Pediatric Critical Care, Regenstrief Center for Biomedical Informatics, Indiana University School of Medicine, 705 Riley Hospital Drive, Riley Phase 2, Rm 4901, Indianapolis, IN 46202–5225. E-mail: crogerso{at}iupui.edu
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