Clinical impact of the High Flow Nasal Cannula in the treatment of asthma crisis in children and adolescents. A pilot study

Asthma is a chronic inflammatory disease and an important cause of hospitalizations in childhood, being its treatment with inhaled corticosteroids and bronchodilators, in addition to the use of Non-Invasive Mechanical Ventilation (NIV). High-Fllow Nasal Cannula (HFNC) has been associated with favorable outcomes in several groups of patients, however it is necessary to understand the clinical impact of this resource in the treatment of asthma attacks. Objectives: To analyze the clinical impact of HFNC and NIV in the treatment of asthmatic children and adolescents in crisis. Methods: Randomized clinical trial with children and adolescents 4-16 years of age, both sexes, hospitalized in a Pediatric Hospital of Sao Paulo, randomized to Treatment 1 (T1) HFNC and Treatment 2 (T2) NIV, evaluated by: Peripheral Oxygen Saturation (SpO2); Severity Score Pediatric Asthma Score (PAS); dose of corticoid and inhaled bronchodilator; days of hospitalization and use of Oxygen. Results: Ten asthmatic subjects were included in each group, age T1 = 7.5 (6-10.5) and T2 = 7 (6-8.5). There was a significant reduction of PAS (10 - 5) in both groups; the difference in initial and final doses of salbutamol was higher in the HFNC group (24 ± 21) vs NIV (10.8 ± 11) p = 0.03; the HFNC group used 1 day less oxygen compared to the NIV group. There was also improvement in the final SpO2 in both groups, with p Conclusion: HFNC showed an efficiency not inferior to NIV, with significant clinical impact with significant reduction of salbutamol use, improvement of SpO2, shorter Oxygen use time and lower severity of asthma crisis.