Early Prediction of High-flow Nasal Cannula Failure Using Pediatric-modified HACOR Score in Children with Acute Hypoxemic Respiratory Distress: A Prospective Observational Study.

Objective: Delayed recognition of treatment failure with heated humidified high-flow nasal cannula (HFNC) in pediatric acute respiratory distress can lead to adverse outcomes. This study presents and verifies a pediatric-modified [heart rate, acidosis, consciousness, oxygenation, respiratory rate (HACOR)] (p-HACOR) score as an instrument for the early prediction of HFNC therapy failure in children experiencing acute hypoxemic respiratory distress. Design: Single-center prospective observational study. Setting: Pediatric intensive care unit (PICU) of a tertiary care teaching hospital in Pune, India. Patients: One hundred and forty-six children (aged 1 month-18 years) admitted to PICU with acute hypoxemic respiratory distress necessitating HFNC therapy. Interventions/measurements: The p-HACOR score-a composite metric incorporating heart rate, acidity, consciousness, oxygenation, and the respiratory rate adjusted for age-specific criteria was assessed at designated intervals: Before initiation and at 1, 6, 12, 24, 36, and 48 hours following commencement of HFNC therapy. Results: Treatment failure was observed in 23 patients (15.8%), with 83% necessitating intubation within 1-2 hours after therapy commencement. The p-HACOR score exhibited superior predictive ability at 1 hour postinitiation, with 91.3% sensitivity, 83.74% specificity, and 84.93% diagnostic accuracy [area under the curve (AUC) 0.951, p < 0.01]. A score threshold exceeding 10.5 at 1 hour proved to be the most dependable predictor of failure. The p-HACOR score showed a high correlation with recognized clinical metrics, exceeding the prognostic accuracy of individual markers. Conclusions: The p-HACOR score may be useful as an early indicator of HFNC therapy failure. Its predictive ability was noted to be best at 1 hour postinitiation of HFNC, suggesting its potential for contributing to early decision-making regarding HFNC failure. How to cite this article: Vora H, Sarangi BU, Walimbe A. Early Prediction of High-flow Nasal Cannula Failure Using Pediatric-modified HACOR Score in Children with Acute Hypoxemic Respiratory Distress: A Prospective Observational Study. Indian J Crit Care Med 2025;29(11):902-906.