Abstract
Objective
This study aims to examine factors associated with High-flow nasal cannula (HFNC) therapy failure in infants with moderate to severe bronchiolitis, thereby optimizing and personalizing management by identifying patients at risk of treatment failure.
Methods
A prospective cohort study was conducted over two years (September 2021 - March 2023) in the pediatric intensive care unit of a tertiary-level university hospital. Infants aged 0–12 months with moderate to severe bronchiolitis requiring HFNC were included. Exclusion criteria were previous noninvasive or invasive mechanical ventilation, tracheostomy, uncorrected cyanotic congenital heart disease, or chronic respiratory or neuromuscular pathology. Clinical and biological characteristics were assessed at initiation and at H2 of HFNC treatment. Logistic regression was used to identify risk factors for HFNC therapy failure.
Results
Of the 154 patients included, 100 (64.9%) responded to HFNC, while 54 (35.1%) required escalation of care. Univariate analysis showed significant differences in age and weight at admission between responders and non-responders. Multivariate analysis identified weight below the 10th percentile, FiO2 requirement ≥ 42.5%, and Wang score ≥ 10 at HFNC initiation as predictors of failure. Persistence of tachycardia, tachypnea, hypercapnia, and FiO2 ≥ 48.5% after 2 hours of HFNC were also predictors of failure. The most frequent causes of HFNC failure were persistent increased respiratory effort (64.8%) and severe apnea (18.5%).
Conclusions
Key predictors of HFNC therapy failure include low weight, high initial FiO2 requirements, and severe clinical scores at initiation, as well as persistent clinical instability during the first hours of therapy. These findings can guide clinical decisions and improve outcomes for infants with bronchiolitis.