Evaluation of prognostic factors for high-flow nasal cannula therapy failure in infants with bronchiolitis: a prospective study.

OBJECTIVE

This study aims to identify factors associated with High-flow nasal cannula (HFNC) therapy failure in infants with moderate to severe bronchiolitis to personalize management and optimize outcomes.

METHODS

A prospective cohort study was conducted from September 2021 to March 2023 in a pediatric intensive care unit. Infants aged 0-12 months with bronchiolitis requiring HFNC were included, excluding those with prior ventilation, tracheostomy, uncorrected cyanotic congenital heart disease, or chronic respiratory/neuromuscular conditions. Clinical and biological characteristics were evaluated at HFNC initiation and after 2 hours. Logistic regression was used to identify predictors of failure.

RESULTS

Of 154 patients, 54 (35.1 %) experienced HFNC failure. 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 ≥ 42.5 %, and Wang score ≥ 10 at initiation as predictors of failure. Persistence of tachycardia, tachypnea, hypercapnia, and FiO2 ≥ 48.5 % after 2 hours were also significant predictors. Common causes of failure were increased respiratory effort (64.8 %) and severe apnea (18.5 %).

CONCLUSIONS

Predictors of HFNC failure include low weight, high initial FiO2, and severe clinical scores, as well as persistent clinical instability during early therapy, aiding clinical decision-making.