Articles Vol. 67 No. 9 25/09/2026

FACTORS ASSOCIATED WITH ADVERSE EVENTS, DURATION OF HIGH-FLOW NASAL CANNULA OXYGEN THERAPY, AND LENGTH OF HOSPITAL STAY IN CHILDREN WITH LOWER RESPIRATORY TRACT INFECTIONS AT VIETNAM NATIONAL CHILDREN’S HOSPITAL

Tran Thi Thuy, Le Thi Hong Hanh
DOI: 10.52163/yhc.v67i9.6769
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Abstract

Aims: To describe the treatment outcomes of high-flow nasal cannula (HFNC) oxygen therapy in children with lower respiratory tract infections and respiratory failure, and to exploratorily analyze selected factors associated with adverse events, duration of HFNC, and length of hospital stay.

Methods: This was a descriptive case-series study combining retrospective and prospective data collection, conducted at the Respiratory Center, Vietnam National Children’s Hospital, from January 2025 to May 2026. The study included 45 children aged 1 to 60 months. Categorical variables were summarized as frequencies and percentages, while quantitative variables were presented as medians and interquartile ranges. Logistic regression was used to exploratorily analyze factors associated with HFNC-related adverse events. Count regression models were used to assess factors associated with the duration of HFNC therapy and length of hospital stay.

Results: The median age was 1 month, and males accounted for 71.1%. The proportions of malnutrition, anemia, and prematurity were 28.9%, 26.7%, and 15.6%, respectively. RSV-associated pneumonia accounted for 84.4%. HFNC obstruction due to secretions occurred in 10 patients (22.2%). The median duration of HFNC therapy was 5 days, and the median length of hospital stay was 13 days. Treatment success was achieved in 43 patients (95.6%), while treatment failure occurred in 2 patients. During HFNC therapy, irritability decreased from 93.3% to 0%, cyanosis from 26.7% to 0%, and chest retraction from 100% to 7.0%. Respiratory rate decreased from 70.0 to 40.0 breaths/min, heart rate from 180.0 to 137.0 beats/min, and the ROX index increased from 4.95 to 7.14 by the end of HFNC therapy; these changes were statistically significant with p<0.001. Regarding blood gas parameters, pH increased from 7.36 to 7.44 and PaCO₂ decreased from 55.2 to 44.4 mmHg, both with statistical significance. PaO₂ and SaO₂ did not change significantly. The PaO₂/FiO₂ ratio decreased significantly after 6 hours of HFNC therapy, then increased again at the end of HFNC therapy. No statistically significant factors were associated with HFNC-related adverse events. Longer duration of illness before admission was independently associated with prolonged HFNC therapy (IRR = 1.03; 95% CI: 1.01–1.06; p = 0.005) and longer hospital stay (IRR = 1.04; 95% CI: 1.01–1.08; p = 0.003).

Conclusion: Clinical signs improved substantially after HFNC therapy, accompanied by a decrease in PaCO₂ and an increase in pH, among children with acute lower respiratory tract infections and respiratory failure. Longer duration of illness before admission was associated with prolonged HFNC therapy and longer hospital stay.

Keywords
high-flow nasal cannula, HFNC, respiratory failure, lower respiratory tract infection, children.
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