The usage of high-flow nasal cannulas (HFNC) is on the rise in the pediatric population. There need to be more objective measures that can be used to predict the results of HFNC. Adults can predict the success or failure of HFNC treatment using the respiratory rate-oxygenation (ROX) and ROX heart rate (ROX-HR) indices. The research compared the 2 indices’ abilities to predict the failure of HFNC therapy in pediatric intensive care unit (PICU) patients. 

A 24-bed pediatric intensive care unit (PICU) at a tertiary care children’s hospital was the setting for this retrospective, longitudinal, observational cohort study. Patients less than or equal to 24 months old who started HFNC in a pediatric intensive care unit (PICU) between January 1, 2018, and August 31, 2020, were considered for inclusion. During HFNC treatment, the ROX and ROX-HR indices were measured at predetermined intervals. The area under the receiver operating characteristic curve (AUROC) and Kaplan-Meier survival analysis was used to assess how well each method performed predicting HFNC failure. To be considered a failure, the patient needed to require either invasive mechanical ventilation or endotracheal intubation to maintain adequate breathing. 

Out of a total of 446 patient contacts, 111 (24.9%) were HFNC therapy failures. It was shown that the ROX and ROX-HR indices were significantly lower at termination for HFNC failure compared to HFNC liberation (P<.001). At 1 (AUROC 0.76, P =.01) and 6 (AUROC 0.81, P =.02), a greater ROX-HR index was related to an increased probability of HFNC failure. 

Patients less than or equal to 24 months who are at risk for HFNC failure may be identified with the help of ROX-HR, allowing for earlier management. The ROX-HR index needs to be validated in pediatric patients. However, this can only be done with larger prospective investigations.