Assessment of outcome and tolerability of high velocity nasal insufflation and continuous positive airway pressure in children with acute respiratory distress

Acute respiratory distress remains a leading cause of mortality in children under five years of age. Non-invasive ventilation (NIV) can reduce the need for invasive mechanical ventilation. This study evaluated outcomes and tolerability of High-Velocity Nasal Insufflation (HVNI) versus Continuous Positive Airway Pressure (CPAP) in children with acute respiratory distress. This prospective cohort study included 80 children (1 month to 5 years) admitted to the PICU with acute respiratory distress after failure of low-flow nasal oxygen therapy. Patients received either HVNI (flow 1–2 L/kg/min; FiO₂ 21–100%) or CPAP (PEEP 5–12 cmH₂O; FiO₂ 21–100%). Patients were monitored for clinical response and readiness for weaning. Lung ultrasound was used to assess lung ultrasound score (LUS), and tolerability was assessed using the FLACC pain scale. Pneumonia was the most common diagnosis in both groups (HVNI: 80%; CPAP: 82.5%, p = 0.78). Median NIV duration was comparable (HVNI: 5 [IQR 4–7] days vs. CPAP: 5 [IQR 4–6] days, p = 0.64), as was PICU length of stay (HVNI: 7 [IQR 6–10] days vs. CPAP: 7 [IQR 6–9] days, p = 0.71). There was no statistically significant difference in PICU outcomes or NIV failure rates between groups (p > 0.05). FLACC scores were lower in the HVNI group (median [IQR]: 2 [1–3] vs. 4 [3–5], p = 0.014), and sedation requirements were higher in the CPAP group (p = 0.016), indicating better tolerability with HVNI. HVNI and CPAP had comparable success rates, NIV failure rates, and PICU length of stay. CPAP was associated with better lung aeration, whereas HVNI was more comfortable and required less sedation. NIV modality should be individualized based on clinical condition and tolerance.