Use of high-flow nasal cannula support in the emergency department reduces the need for intubation in pediatric acute respiratory insufficiency

UMMS Affiliation

Department of Pediatrics



Document Type


Medical Subject Headings

Respiratory Insufficiency; Noninvasive Ventilation; Intubation; Emergency Service, Hospital; Intensive Care Units, Pediatric; Child


Critical Care | Emergency Medicine | Pediatrics | Respiratory Tract Diseases


OBJECTIVES: The objective of this study was to determine whether the use of heated, humidified, high-flow nasal cannula (HFNC) therapy is associated with a decreased need for intubation in patients presenting to a pediatric emergency department (PED) and admitted to a pediatric intensive care unit (PICU) with acute respiratory insufficiency (ARI).

METHODS: A retrospective study of all patients admitted from the PED to the PICU with ARI from January 2006 through December 2009. Patients admitted before the availability of HFNC (cohort 1) were compared with those admitted after the availability of HFNC but before implementation of an institution-wide guideline on pediatric HFNC usage (cohort 2) and those admitted after the implementation of a pediatric HFNC usage guideline (cohort 3).

RESULTS: After controlling for age, month of admission, type of respiratory illness, and severity of illness, there was an 83% reduction in the odds of intubation in the PED in cohort 3 compared with cohort 1 (odds ratio, 0.17; 95% confidence interval, 0.06-0.50; P = 0.001). There was no significant change in mortality or median PICU length of stay after the introduction of HFNC.

CONCLUSIONS: High-flow nasal cannula used early in the development of pediatric ARI is associated with a decreased the need for intubation and mechanical ventilation.

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Citation: Pediatr Emerg Care. 2012 Nov;28(11):1117-23. doi: 10.1097/PEC.0b013e31827122a9. Link to article on publisher's site

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