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A review of the use of high flow nasal cannula oxygen therapy in hospitalized children at a regional hospital in the Cape Town Metro, South Africa
Background: High-flow nasal cannula oxygen (HFNC) is a non-invasive alternative to nasal continuous positive pressure oxygen (CPAP) therapy for infants and children requiring respiratory support. There is a paucity of literature to support its use in children, with no published data from sub-Saha...
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| Other Authors: | |
| Format: | Thesis |
| Language: | English |
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Department of Paediatrics and Child Health
2019
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| _version_ | 1867613224259551232 |
|---|---|
| access_status_str | Open Access |
| author | Hoffman, Elizabeth |
| author2 | Cooke, Melissa Louise |
| author_browse | Cooke, Melissa Louise Hoffman, Elizabeth |
| author_facet | Cooke, Melissa Louise Hoffman, Elizabeth |
| author_sort | Hoffman, Elizabeth |
| collection | Thesis |
| description | Background: High-flow nasal cannula oxygen (HFNC) is a non-invasive alternative
to nasal continuous positive pressure oxygen (CPAP) therapy for infants and
children requiring respiratory support. There is a paucity of literature to support its
use in children, with no published data from sub-Saharan Africa.
Objective: To describe the outcomes and adverse events of HFNC in the first year of
its use in a level two (L2) general paediatric ward, compared with outcomes of a
historical cohort when this intervention was unavailable.
Methods: This retrospective descriptive study included children aged <13 years who
received HFNC in the first 12 months after its introduction (HFNC-availability group;
n=66). Demographic data, clinical characteristics, and outcomes (death, treatment
failure, length of HFNC, and HFNC-related adverse events) were assessed. A
comparative description of children that required transfer to level 3 (L3) for
respiratory support (more than available standard low-flow oxygen) in the 12-month
period prior to HFNC availability (pre-HFNC group; n=54) was performed and
outcomes were compared using standard descriptive and comparative statistics.
Results: The median age of the cohort was 5 months (interquartile range [IQR] 1.9–
14.6). Sixteen children (13.3%) were malnourished, 10 (8%) were HIV infected, and
30 (25%) were ex-premature infants. The most common diagnoses were
pneumonia, bronchiolitis, and asthma. Asthma, anaemia, and cardiac abnormalities
were the most prevalent underlying co-morbidities. Two children died in each group.
All 54 children in the pre-HFNC group were transferred to L3; 38 (70.4%) needed
CPAP or invasive ventilation. In the HFNC-availability period, 85 children were
assessed as needing more than standard low-flow oxygen therapy: 19 were
immediately transferred to L3 where 17 (89.4%) received CPAP or invasive
ventilation; 66 received HFNC at L2, 16 (24.2%) of these children required transfer
to L3 for CPAP or invasive ventilation. The median duration of HFNC was 46.3 h
(IQR 19.5–93.5) overall, and was 12 h (IQR 4-28) and 58.5 h (IQR 39.5–106) for
those who failed or were successfully managed on HFNC, respectively. No HFNCrelated serious adverse events were recorded at L2.
Conclusion: HFNC is a safe, effective, feasible option for non-invasive ventilation of
children with respiratory illnesses in a resource-limited L2 setting. A greater
proportion of children admitted with lower respiratory tract infections required
support in the HFNC-availability group, but the intervention reduced the bed- pressure on L3. Improved identification of HFNC failures and better adherence to
the protocol is needed at L2. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/30128 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| last_indexed | 2026-06-10T12:32:44.899Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2019 |
| publishDateRange | 2019 |
| publishDateSort | 2019 |
| publisher | Department of Paediatrics and Child Health |
| publisherStr | Department of Paediatrics and Child Health |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/30128 A review of the use of high flow nasal cannula oxygen therapy in hospitalized children at a regional hospital in the Cape Town Metro, South Africa Hoffman, Elizabeth Cooke, Melissa Louise Background: High-flow nasal cannula oxygen (HFNC) is a non-invasive alternative to nasal continuous positive pressure oxygen (CPAP) therapy for infants and children requiring respiratory support. There is a paucity of literature to support its use in children, with no published data from sub-Saharan Africa. Objective: To describe the outcomes and adverse events of HFNC in the first year of its use in a level two (L2) general paediatric ward, compared with outcomes of a historical cohort when this intervention was unavailable. Methods: This retrospective descriptive study included children aged <13 years who received HFNC in the first 12 months after its introduction (HFNC-availability group; n=66). Demographic data, clinical characteristics, and outcomes (death, treatment failure, length of HFNC, and HFNC-related adverse events) were assessed. A comparative description of children that required transfer to level 3 (L3) for respiratory support (more than available standard low-flow oxygen) in the 12-month period prior to HFNC availability (pre-HFNC group; n=54) was performed and outcomes were compared using standard descriptive and comparative statistics. Results: The median age of the cohort was 5 months (interquartile range [IQR] 1.9– 14.6). Sixteen children (13.3%) were malnourished, 10 (8%) were HIV infected, and 30 (25%) were ex-premature infants. The most common diagnoses were pneumonia, bronchiolitis, and asthma. Asthma, anaemia, and cardiac abnormalities were the most prevalent underlying co-morbidities. Two children died in each group. All 54 children in the pre-HFNC group were transferred to L3; 38 (70.4%) needed CPAP or invasive ventilation. In the HFNC-availability period, 85 children were assessed as needing more than standard low-flow oxygen therapy: 19 were immediately transferred to L3 where 17 (89.4%) received CPAP or invasive ventilation; 66 received HFNC at L2, 16 (24.2%) of these children required transfer to L3 for CPAP or invasive ventilation. The median duration of HFNC was 46.3 h (IQR 19.5–93.5) overall, and was 12 h (IQR 4-28) and 58.5 h (IQR 39.5–106) for those who failed or were successfully managed on HFNC, respectively. No HFNCrelated serious adverse events were recorded at L2. Conclusion: HFNC is a safe, effective, feasible option for non-invasive ventilation of children with respiratory illnesses in a resource-limited L2 setting. A greater proportion of children admitted with lower respiratory tract infections required support in the HFNC-availability group, but the intervention reduced the bed- pressure on L3. Improved identification of HFNC failures and better adherence to the protocol is needed at L2. 2019-05-15T10:44:15Z 2019-05-15T10:44:15Z 2018 2019-05-15T10:25:30Z Master Thesis Masters MMed http://hdl.handle.net/11427/30128 eng application/pdf Department of Paediatrics and Child Health Faculty of Health Sciences |
| spellingShingle | Hoffman, Elizabeth A review of the use of high flow nasal cannula oxygen therapy in hospitalized children at a regional hospital in the Cape Town Metro, South Africa |
| thesis_degree_str | Master's |
| title | A review of the use of high flow nasal cannula oxygen therapy in hospitalized children at a regional hospital in the Cape Town Metro, South Africa |
| title_full | A review of the use of high flow nasal cannula oxygen therapy in hospitalized children at a regional hospital in the Cape Town Metro, South Africa |
| title_fullStr | A review of the use of high flow nasal cannula oxygen therapy in hospitalized children at a regional hospital in the Cape Town Metro, South Africa |
| title_full_unstemmed | A review of the use of high flow nasal cannula oxygen therapy in hospitalized children at a regional hospital in the Cape Town Metro, South Africa |
| title_short | A review of the use of high flow nasal cannula oxygen therapy in hospitalized children at a regional hospital in the Cape Town Metro, South Africa |
| title_sort | review of the use of high flow nasal cannula oxygen therapy in hospitalized children at a regional hospital in the cape town metro south africa |
| url | http://hdl.handle.net/11427/30128 |
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