Analysis Of The Efficacy Of High-Flow Nasal Cannula Oxygen Therapy In Children With Severe Pneumonia

Objective:To observe the effect of high-flow nasal cannula oxygen therapy versus conventional oxygen therapy in the respiratory support of children with severe pneumonia.To clarify the clinical efficacy of HFNC in children with severe pneumonia and to provide a clinical reference for optimising the oxygen therapy protocol for children with severe pneumonia.Methods:This study was a retrospective study,and children aged 1 month-6 years who were admitted to the paediatric department of the Affiliated Hospital of Yan’an University for treatment of severe pneumonia from January 2021 to January 2023 were strictly selected according to the inclusion criteria as the study population.Due to the limited equipment in the paediatric department of the Affiliated Hospital of Yan’an University,there were only three transnasal high-flow oxygen therapy instruments available at present.Children admitted to the paediatric department of the Affiliated Hospital of Yan’an University for treatment of severe pneumonia were selected by random sampling method and randomly divided into HFNC group and conventional oxygen therapy group.After admission,the children in both groups were treated according to the pneumonia treatment protocol,except for the different modes of oxygen administration,including keeping the airway open,applying antibiotics if necessary,relieving spasm,resolving sputum,actively preventing and controlling complications,paying attention to rest,and strengthening dietary regimen.The basic data of both groups were collected,the characteristics of respiratory status at admission（presence of moaning,nasal flapping,triple concave sign）,before the start of treatment,2h,24h,48h after treatment:RR,HR,Sp O₂,PH,Pa O₂,Pa CO₂.The time of relief of respiratory distress,time of stabilisation and time of disappearance of pulmonary rales were recorded in both groups.The comfort of the children was recorded using the Children’s Pain Assessment Scale and the occurrence of complications（facial skin damage,nasal mucous membrane damage,abdominal distension）was observed in both groups.Statistical treatment was also performed.Results:1.A total of 116 children with severe pneumonia met the diagnostic criteria,and a total of 16 children who did not meet the inclusion criteria were excluded by combining the exclusion criteria.A total of 100 children with severe pneumonia were included,including 50 in the HFNC group and 50 in the COT group.The distribution of children in the two groups was similar in terms of gender,age and weight,with no statistical differences（P>0.05）;meanwhile,there were no statistically significant differences（P>0.05）when comparing the Sp O₂,respiratory status characteristics,emergency blood gas analysis values taken on admission and RR and HR of children aged1 month-1 year in the two groups.2.A comparison of the vital signs and blood gases of the children in the HFNC group before and after treatment showed that Sp O₂ rebounded significantly,PH gradually returned to the normal range,Pa O₂ improved significantly,and Pa CO₂ decreased compared with that before hospitalisation,and RR and HR were significantly lower in children aged1 month-1 year compared with those before hospitalisation.Sp O₂,PH,Pa O₂ and Pa CO₂ in the COT group,and RR and HR in children aged 1 month-1 year also improved compared with those before admission,and the differences were statistically significant（P<0.05）.The overall effect of the treatment was that both HFNC oxygen therapy and COT oxygen therapy improved the clinical symptoms and oxygen saturation of the children with severe pneumonia.3.After 2h of oxygen therapy,there were statistically significant differences in Sp O₂,PH,Pa O₂,Pa CO₂ and RR in children aged 1 month-1 year between the HFNC and COT groups（p<0.05）,but not in HR in this age group（p>0.05）.This suggests that the use of HFNC can rapidly increase Sp O₂ and improve related blood gas parameters more rapidly than COT,and that early treatment with HFNC can rapidly reduce RR in children aged 1month-1 year,while there is no significant difference between the two groups in terms of HR reduction.4.After 24h of oxygen therapy,Pa CO₂ in the two groups showed a decreasing trend,but the difference was not statistically significant（P>0.05）.Sp O₂ in the HFNC and COT groups continued to rise,PH fluctuated in the normal range,Pa O₂ showed a gradual increase,and RR and HR gradually approached the normal range in children aged 1 month to 1 year.The difference between the two groups was statistically significant（P<0.05）.It was suggested that after 24h of treatment,the Sp O2,PH and Pa O2 in the HFNC group and the RR and HR in the children aged 1 month-1 year showed good improvement compared with the COT group.5.After 48h of oxygen therapy,the HFNC group still had a good improvement in Sp O₂and RR and HR in children aged 1 month-1 year compared to the COT group,the difference was statistically significant（P<0.05）,PH and Pa O₂ had been maintained in the normal range in both groups and Pa O₂ was still on the rise,the difference was statistically significant（P<0.05）.However,the difference was not statistically significant when comparing Pa CO₂ between the two groups of children（P>0.05）.It is suggested that the HFNC group still has a better advantage in improving Sp O₂,PH,Pa O₂ and RR and HR in children aged 1 month-1 year after 48h of treatment.6.The differences between the two groups were statistically significant（p<0.05）in terms of the speed of reduction in dyspnoea and the time to stabilisation before and after treatment.However,there was no statistically significant difference between the two groups in terms of time to resolution of pulmonary rales and number of days in hospital（p>0.05）.In terms of hospital costs,the difference between the two groups was statistically significant（P<0.05）.This suggests that the HFNC group could provide more rapid relief of dyspnoea and stabilisation than the COT group,but there was no significant difference in the time to resolution of pulmonary rales and the number of days in hospital between the two groups,suggesting that HFNC may not shorten the course of severe pneumonia in children.The cost of hospitalisation was slightly higher in the HFNC group than in the COT group.7.The difference between the comfort scores of the HFNC group and the COT group during the admission of both groups was statistically significant（p<0.05）,indicating that the children in the HFNC group were more comfortable and easily accepted by the children.Facial injury and nasal mucosal injury were observed in both groups during oxygen therapy and the difference between the two groups was statistically significant.A comparison of abdominal distension between the two groups revealed that there was no abdominal distension in the HFNC group and the difference was statistically significant,suggesting that the HFNC group had fewer complications and was safer than the COT group.Conclusions:1.HFNC has been shown to be effective in respiratory support for children with severe pneumonia.Compared to COT,HFNC rapidly relieves dyspnoea,increases oxygen saturation and arterial partial pressure,and stabilises the condition more rapidly.In children aged 1 month to 1 year with severe pneumonia,HFNC can rapidly reduce respiratory rate and heart rate.2.There was no significant difference between the HFNC group and the COT group in terms of time to resolution of lung rales and length of hospital stay.However,the cost of hospitalisation was slightly higher in the HFNC group than in the COT group.3.The HFNC mode of oxygen therapy for children with severe pneumonia is more comfortable and easily accepted by the children,while the HFNC group has fewer complications and is safer in terms of facial skin damage,nasal mucosal damage and abdominal distension.