High flow nasal cannula use is associated with increased hospital length of stay for pediatric asthma

Pediatr Pulmonol. 2023 Nov;58(11):3046-3053. doi: 10.1002/ppul.26617. Epub 2023 Aug 2.


Background: High flow nasal cannula (HFNC) is a respiratory device increasingly used to treat asthma. Recent mechanistic studies have shown that nebulized medications may have reduced delivery with HFNC, which may impair asthma treatment. This study evaluated the association between HFNC use for pediatric asthma and hospital length of stay (LOS).

Methods: This was a retrospective matched cohort study. Cases included patients aged 2-18 years hospitalized between January 2010 and December 2021 with asthma and received HFNC treatment. Controls were selected using logistic regression propensity score matching based on demographics, vital signs, medications, imaging, and social and environmental determinants of health. The primary outcome was hospital LOS.

Results: A total of 23,659 encounters met eligibility criteria, and of these 1766 cases included HFNC treatment with a suitable matched control. Cases were well-matched in demographics, social and environmental determinants of health, and clinical characteristics including use of adjunctive asthma therapies. The median hospital LOS for study cases was significantly higher at 87 h (interquartile range [IQR]: 61-145) compared to 66 h (IQR: 43-105) in the matched controls (p < 0.01). There was no significant difference in the rate of intubation and mechanical ventilation (8.9% vs. 7.6%, p = .18); however, the use of NIV was significantly higher in the cases than the control group (21.3% vs. 6.7%, p < .01).

Conclusion: In this study of children hospitalized for asthma, HFNC use was associated with increased hospital LOS compared to matched controls. Further research using more granular data and additional relevant variables is needed to validate these findings.

Keywords: critical care; informatics; pediatrics; pulmonology.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Asthma* / therapy
  • Cannula
  • Child
  • Cohort Studies
  • Hospitals
  • Humans
  • Length of Stay
  • Noninvasive Ventilation* / methods
  • Oxygen Inhalation Therapy
  • Respiratory Insufficiency* / therapy
  • Retrospective Studies