Comparative Analysis of High-Flow Nasal Cannula Oxygen Therapy and Invasive Mechanical Ventilation in the Management of Severe Pneumonia: A Retrospective Study.

BACKGROUND

Severe pneumonia continues to be a prominent cause of hospitalization and global mortality. There is ongoing debate regarding the effectiveness of different oxygen therapy modalities, particularly high-flow nasal cannula (HFNC) oxygen therapy and invasive mechanical ventilation (IMV), in the treatment of severe pneumonia.

OBJECTIVE

This study investigated the risk factors associated with mechanical ventilation in pediatric patients with severe pneumonia.

METHODS

This retrospective study included a cohort of 240 pediatric patients with severe pneumonia treated at Zhangzhou Hospital, affiliated with Fujian Medical University, from January 2019 to December 2020. Patients were categorized into two groups: the HFNC group and the IMV group. Comparative analysis was performed on general patient information, infection markers, arterial blood gas values, as well as the prevalence of underlying conditions and complications between the two groups. Multivariate logistic regression analysis was employed to identify the risk factors for invasive mechanical ventilation in children with severe pneumonia.

RESULTS

Patients in the HFNC group experienced shorter hospitalization durations, and the average age in this group was lower compared to the IMV group (P < .05). Upon admission, respiratory rate and heart rate were higher in the HFNC group compared to the IMV group (P < .05). The IMV group demonstrated higher oxygenation index (OI) and infection markers, while the pH level was lower in the IMV group than in the HFNC group (P < .05). The prevalence of underlying conditions and complications in the IMV group was significantly higher than in the HFNC group (P < .05). Basic conditions such as heart disease, prematurity, heart failure, low OI, toxic encephalopathy, and influenza virus infection were identified as risk factors for IMV.

CONCLUSIONS

High-flow nasal cannula therapy has shown therapeutic efficacy in pediatric patients with severe pneumonia. However, children with underlying medical conditions may require prompt tracheal intubation and invasive mechanical ventilation.