Comparative Evaluation of High-Flow Nasal Cannula Therapy Versus Conventional Oxygen Therapy in Children with Acute Lower Respiratory Tract Infections

Background: Acute lower respiratory tract infections (ALRTIs) are a major cause of morbidity and hospitalization among children under five years of age. High-Flow Nasal Cannula (HFNC) therapy has emerged as an effective non-invasive respiratory support modality that may provide better oxygenation and clinical outcomes than Conventional Oxygen Therapy (COT). This study compared the efficacy and outcomes of HFNC with COT in children with ALRTIs presenting with hypoxemic respiratory distress.

Methods: This prospective comparative observational study was conducted in the Department of Pediatrics, ESIC Medical College and Hospital, Kalaburagi, Karnataka, from April 2025 to April 2026. A total of 94 children aged 1 month to 5 years with ALRTIs requiring supplemental oxygen were enrolled and divided into two groups: HFNC (n=47) and Conventional Oxygen Therapy (n=47). Baseline demographic and clinical characteristics were recorded. Clinical parameters including respiratory rate, heart rate, oxygen saturation (SpO₂), treatment success, need for escalation of respiratory support, mechanical ventilation, PICU admission, duration of oxygen therapy, length of hospital stay, and mortality were compared between the two groups. Statistical analysis was performed using SPSS version 26.0, with a p-value <0.05 considered statistically significant.

Results: Baseline demographic characteristics and disease severity were comparable between the two groups. After 24 hours of therapy, children receiving HFNC showed significantly lower respiratory rate (42.1 ± 5.3 vs. 47.9 ± 6.4 breaths/min; p<0.001), lower heart rate (128.5 ± 10.8 vs. 136.7 ± 12.1 beats/min; p=0.001), and higher oxygen saturation (97.1 ± 1.3% vs. 95.2 ± 1.8%; p<0.001) compared with the COT group. Treatment success was significantly higher with HFNC (91.5% vs. 74.5%; p=0.028), while treatment failure requiring escalation of respiratory support was significantly lower (8.5% vs. 25.5%; p=0.028). The duration of oxygen therapy (2.8 ± 0.9 vs. 4.1 ± 1.3 days; p<0.001) and length of hospital stay (4.6 ± 1.5 vs. 6.2 ± 1.9 days; p<0.001) were significantly shorter in the HFNC group. Although mechanical ventilation (4.3% vs. 14.9%) and PICU admission (10.6% vs. 23.4%) were less frequent with HFNC, these differences were not statistically significant. Mortality was low, with one death occurring in the COT group.

Conclusion: HFNC therapy was more effective than Conventional Oxygen Therapy in improving oxygenation, reducing respiratory distress, increasing treatment success, and shortening oxygen requirement and hospital stay in children with acute lower respiratory tract infections. HFNC represents a safe and effective first-line non-invasive respiratory support strategy for pediatric patients with hypoxemic ALRTIs and may reduce the need for escalation of respiratory support