Efficacy And Safety Of High-flow Nasal Cannula Oxygen Therapy On Respiratory Failure After Pediatric Surgery And Trauma

Background and objective:High-flow nasal cannula(HFNC)is a relatively new non-invasive ventilation therapy.The use of HFNC is increasing in neonates and children.The purpose of this study is to determine the beneficial effects and safety of HFNC on respiratory failure after pediatric surgery and trauma,and analyse the risk factors for failure of HFNC in children with respiratory failure.Methods:Seventy-four patients with respritatory failure after pediatric surgery and trauma,who received HFNC oxygen therapy in the Department of Surgical Intensive Care Unit(SICU)of the children's hospital of Zhejiang University School of Medicine from January 2015 to May 2019,were admitted into this retropective study.The children were divided into two disease groups according to the underlying diseases: the respiratory failure group caused by trauma such as accident,fall,and the respiratory failure group after elective surgery.Then,according to different surgical sites,they were further divided into craniocerebral postoperative group,cervical and thoracic postoperative group,and abdominal postoperative group.All the included patients were divided into two groups according to whether respiratory failure improved after HFNC treatment: HFNC success group and HFNC failure group.We collected clinical datas of study subjects and compared them in groups.Results:1.Clinical features: Among the 74 children,20 children(27.0%)were in the trauma group,54 children(73.0%)were in the elective surgery group,of which 14children(19.0%)were in the craniocerebral postoperative group,and 20 children(27.0%)were in the cervical and thoracic postoperative group and 20 children(27.0%)were in the abdominal postoperative group.59 patients(79.7%)in the HFNC success group and 15 patients(20.3%)in the HFNC failure group.7 children required intubation,and the intubation rate was 9.5%.7 children died and the mortality was8.1%.The length of ICU stay was 10.00±9.33 days,and the total hospital stay was26.42±14.50 days.18 children(24.3%)of all children had adverse reactions,such as nasal injury,distension,and air leak syndrome.2.HFNC can significantly improve the oxygenation of children with respiratory failure after trauma and surgery.Pa O?,PH,lactic acid,SPO?,Pa O?/ Fi O? are significantly improved compared with pretreatment(P<0.05).Compared with Pa CO?at different time points before and after treatment,there was no significant difference(P>0.05).3.There were no significant differences in success rate of HFNC trerapy,tracheal intubation rate and mortality rate in the trauma group,craniocerebral postoperative group,cervical and thoracic postoperative group and abdominal postoperative group(P>0.05);The incidence of adverse events was not statistically significant(P>0.05).4.The average length of ICU stay in children with HFNC success and failure respectively was 8.81 ± 8.78 days and 15.71 ± 12.04 days,and the difference between the two groups was statistically significant(P<0.05).The Glasgow coma score(GCS),p H value,and oxygenation index before implementing respiratory support in the HFNC failure group were significantly lower than those in the HFNC success group(P<0.05),while the Pediatric Risk of Mortality Score and lactic acid ratio were significantly higher than those in the HFNC success group(P<0.05).The proportion of children with GCS score <11 and PRISM score> 5.0 in HFNC failure group was higher than that in HFNC success group(P<0.05).5.There were no statistically significant differences in the incidence of various adverse events of nasal injury,distension,and air leak syndrome treated with HFNC in the trauma group,the craniocerebral postoperative group,the cervical and thoracic postoperative group and the abdominal surgery group(P<0.05).Conclusion:1.HFNC can improve oxygenation in children with respiratory failure after trauma and surgery.2.There were no significant differences in the success rate of HFNC,intubation rate and mortality in children with respiratory failure after trauma,craniocerebral surgery,cervical and thoracic surgery,and abdominal surgery who were treated with HFNC.3.Failure of HFNC on respiratory failure after pediatric trauma and surgery may prolong the length of stay in ICU.4.Children with respiratory failure after trauma and surgery who have GCS score<11 or PRISM score>5.0 have relatively high risk of HFNC failure.5.There were no significant differences in the incidence of various adverse events of nasal injury,distension,and air leak syndrome treated with HFNC in respitatory faiure after pediatric trauma group,craniocerebral postoperative group,cervical and thoracic postoperative group,and abdominal postoperative group.