O0572 Oct.4: 10:37am - Use of High-Flow Nasal Cannula vs Conventional Oxygen Therapy in Pediatric Asthma Exacerbations

Background:
Asthma is the leading chronic disease in children. When children present with an asthma exacerbation (AE), they are frequently managed with steroids, bronchodilators, and oxygen support. High flow nasal cannula (HFNC) is a method of delivering inspired oxygen rapidly via nasal cannula. HFNC has become popular to use in pediatric AEs, due to its safety and convenience of use a medication delivery method. However, there is limited data on its efficacy in AE management.

Objective:
We aim to assess patient outcomes when treated with HFNC versus conventional oxygen (ConO2) for pediatric AEs at UF Health Children’s Hospital. For our study, outcomes are defined as change in asthma severity score in the first 2 hours post treatment, length of stay (LOS), and rate of patient transfer to the pediatric intensive care unit (PICU).
Design/

Methods:
We conducted a retrospective analysis of children (age 5-17 years old) with an AE admitted to UF Health Children’s Hospital from Jan 2017-Jan 2019. Patients treated with HFNC were compared to patients treated with ConO2 in terms of their AE severity and time to recovery. AE severity was assessed using a pediatric asthma severity score (PASS) ranging from 0 to 12, with 0 being normal respiratory exam. A sub study was performed to address higher severity exacerbations, as defined by patients scoring a maximum PASS >5. The reduction in PASS scores in the first 2 hours, LOS, and rate of transfers to the PICU were studied in both groups.

Results:
A total of 198 patients were studied, with 63 receiving HFNC and 135 receiving ConO2. For HFNC patients, the mean reduction in PASS in first 2 hours was (-) 1.2, compared to (-) 2.6 in the ConO2 group (p-value <0.001). The mean LOS was 50 hours in the HFNC group, compared to 24 hours for ConO2 patients (p-value <0.01). Additionally, in the severe AE cohort, there were 57 HFNC patients and 74 ConO2 patients. For HFNC patients, the mean LOS was 53 hours, compared to 24 hours for the ConO2 patients (p-value <0.01). This represents a statistically significant increased LOS for HFNC patients with similar severity of AE. Overall in our complete cohort, the percent of PICU transfers was equal between the two groups (~20% for each).

Conclusion:
Use of HFNC in the management of pediatric AE is not superior to ConO2 in reducing PASS scores after 2 hours of treatment. HFNC use is associated with longer hospital stay even when controlled for AE severity. Use of HFNC for AE is associated with a similar rate of PICU transfers as patients receiving ConO2. Therefore, this study shows no evidence of improved outcomes or faster resolution of AE with the use of HFNC.