{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T05:05:09Z","timestamp":1779944709287,"version":"3.53.1"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T00:00:00Z","timestamp":1775865600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Use of heated humidified high flow nasal cannula (HFNC) has become the standard treatment modality for children with acute respiratory distress. This study aimed to identify the factors predicting HFNC failure. Methodology: Children 1\u2009month\u201312\u2009years of age requiring HFNC support were included in this prospective observational study. Vital signs, e.g. heart rate, respiratory rate (RR), Respiratory Clinical Score (RCS), indices, e.g. SF ratio (SpO2\/FiO2) and ROX index (SF\/RR) and patient outcomes regarding HFNC success or failure were recorded. Receiver operating characteristics (ROC) analysis with area under the curve (AUC) was done at different time points to find the best cut-off value for SF ratio and ROX index as predictors of HFNC failure. Results: Sixty children requiring HFNC were enrolled. Initial response in the RCS score occurred in 46 patients at 4\u2009hours (interquartile range [IQR]: 2\u20136) and in RR 6\u2009hours (IQR: 4\u201312). All patients except one (45\/46) who had shown the initial response finally responded to HFNC therapy (75%), and the remaining 15\/60 (25%) required escalation to invasive ventilation. Best cut-off value of the SF ratio was \u2264192 at 12\u2009hours, with 84.4% sensitivity and 84.6% specificity (AUC, 0.819). Similarly, the best ROX index value to predict HFNC failure was \u22645.27 at 24\u2009hours with 72.1% sensitivity and 88.9% specificity (AUROC 0.864). Conclusion: SF ratio at 12\u2009hours and ROX index at 24\u2009hours are best for predicting HFNC failure in children. Initial response in the RCS score (20% reduction from baseline) by 4\u2009hours is also a good indicator of HFNC success, as none (except one) of these patients failed HFNC therapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/tropej\/fmag034","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T11:36:37Z","timestamp":1778153797000},"source":"Crossref","is-referenced-by-count":0,"title":["Predictors of failure of high flow nasal cannula oxygen therapy in children: a prospective observational study"],"prefix":"10.1093","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-1624-7245","authenticated-orcid":false,"given":"Puneet","family":"Mishra","sequence":"first","affiliation":[{"name":"Department of Community Medicine, Maulana Azad Medical College , New Delhi 110002,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1734-3504","authenticated-orcid":false,"given":"Urmila","family":"Jhamb","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Santosh Medical College and Hospital , Ghaziabad 201009,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9211-5793","authenticated-orcid":false,"given":"Pallavi","family":"Pallavi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Maulana Azad Medical College , New Delhi 110002,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8518-5504","authenticated-orcid":false,"given":"Romit","family":"Saxena","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Maulana Azad Medical College , New Delhi 110002,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,5,27]]},"reference":[{"key":"2026052800335328800_fmag034-B1","doi-asserted-by":"crossref","first-page":"3","DOI":"10.3345\/kjp.2019.00626","article-title":"High-flow nasal cannula oxygen therapy in children: a clinical review","volume":"63","author":"Kwon","year":"2020","journal-title":"Clin Exp Pediatr"},{"key":"2026052800335328800_fmag034-B2","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1097\/PEC.0b013e31827122a9","article-title":"Use of high-flow nasal cannula support in the emergency department reduces the need for intubation in pediatric acute respiratory insufficiency","volume":"28","author":"Wing","year":"2012","journal-title":"Pediatr Emerg Care"},{"key":"2026052800335328800_fmag034-B3","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/s13613-014-0029-5","article-title":"High flow nasal cannula: recommendations for daily practice in pediatrics","volume":"4","author":"Mil\u00e9si","year":"2014","journal-title":"Ann Intensive Care"},{"key":"2026052800335328800_fmag034-B4","doi-asserted-by":"crossref","first-page":"1299","DOI":"10.1007\/s00431-018-3191-1","article-title":"Using a high-flow nasal cannula provides superior results to OxyMask delivery in moderate to severe bronchiolitis: a randomized controlled study","volume":"177","author":"Ergul","year":"2018","journal-title":"Eur J Pediatr"},{"key":"2026052800335328800_fmag034-B5","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1111\/jpc.14496","article-title":"Rational use of high-flow therapy in infants with bronchiolitis. What do the latest trials tell us? A paediatric research in emergency departments international collaborative perspective","volume":"55","author":"O\u2019Brien","year":"2019","journal-title":"J Paediatr Child Health"},{"key":"2026052800335328800_fmag034-B6","doi-asserted-by":"crossref","first-page":"1718","DOI":"10.1007\/s00134-001-1114-4","article-title":"Predictors of failure of noninvasive positive pressure ventilation in patients with acute hypoxemic respiratory failure: a multi-center study","volume":"27","author":"Antonelli","year":"2001","journal-title":"Intensive Care Med"},{"key":"2026052800335328800_fmag034-B7","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/j.jcrc.2016.05.022","article-title":"Predicting success of high-flow nasal cannula in pneumonia patients with hypoxemic respiratory failure: the utility of the ROX index","volume":"35","author":"Roca","year":"2016","journal-title":"J Crit Care"},{"key":"2026052800335328800_fmag034-B8","doi-asserted-by":"crossref","first-page":"5","DOI":"10.4103\/lungindia.lungindia_122_21","article-title":"Predictive factors for high-flow nasal cannula failure in acute hypoxemic respiratory failure in an intensive care unit","volume":"39","author":"Lun","year":"2022","journal-title":"Lung India"},{"key":"2026052800335328800_fmag034-B9","doi-asserted-by":"publisher","first-page":"595","DOI":"10.3345\/cep.2022.00241","article-title":"Predictors of high-flow nasal cannula failure in pediatric patients with acute respiratory distress","volume":"65","author":"Saelim","year":"2022","journal-title":"Clin Exp Pediatr"},{"key":"2026052800335328800_fmag034-B10","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1186\/s12890-024-03029-2","article-title":"Respiratory rate oxygenation (ROX) index as predictor of high flow nasal cannula in pediatric patients in pediatric intensive care unit","volume":"24","author":"Yuniar","year":"2024","journal-title":"BMC Pulm Med"},{"key":"2026052800335328800_fmag034-B11","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1007\/s00431-020-03847-6","article-title":"Predicting nasal high-flow therapy failure by pediatric respiratory rate-oxygenation index and pediatric respiratory rate-oxygenation index variation in children","volume":"180","author":"Yildizdas","year":"2021","journal-title":"Eur J Pediatr"},{"key":"2026052800335328800_fmag034-B12","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1007\/s00134-011-2177-5","article-title":"Reduced intubation rates for infants after introduction of high-flow nasal prong oxygen delivery","volume":"37","author":"Schibler","year":"2011","journal-title":"Intensive Care Med"},{"key":"2026052800335328800_fmag034-B13","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1002\/ppul.10425","article-title":"Use of a respiratory clinical score among different providers","volume":"37","author":"Liu","year":"2004","journal-title":"Pediatr Pulmonol"},{"key":"2026052800335328800_fmag034-B14","doi-asserted-by":"crossref","first-page":"1276","DOI":"10.4187\/respcare.07403","article-title":"Factors associated with failure of high-flow nasal cannula","volume":"65","author":"Kim","year":"2020","journal-title":"Respir Care"},{"key":"2026052800335328800_fmag034-B15","doi-asserted-by":"crossref","first-page":"13439","DOI":"10.1038\/s41598-021-92893-7","article-title":"SpO2\/FiO2 as a predictor of high flow nasal cannula outcomes in children with acute hypoxemic respiratory failure","volume":"11","author":"Kim","year":"2021","journal-title":"Sci Rep"},{"key":"2026052800335328800_fmag034-B16","first-page":"e229-35","article-title":"Factors associated with treatment failure of high-flow nasal cannula among children with 100 bronchiolitis: a single-centre retrospective study","volume":"26","author":"D\u2019Alessandro","year":"2020","journal-title":"Paediatr Child Health"},{"key":"2026052800335328800_fmag034-B17","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1002\/ppul.23626","article-title":"High flow nasal cannula use outside of the ICU; 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