Morris JV, et al. - In this retrospective analysis, researchers used data collected prospectively by the Paediatric Intensive Care Audit Network, including 34 PICUs in the United Kingdom and Republic of Ireland, to analyze trends in high-flow nasal cannula therapy use, to differentiate patients started on high-flow nasal cannula from those started on noninvasive ventilation, as well as to determine if there was a difference between patients who failed high-flow nasal cannula therapy vs those who did not. Overall, 26,423 admissions were assessed; 5,951 (22.5%) managed with high-flow nasal cannula at some point during the PICU stay. In 2,080 (7.9%) and 978 admissions, first-line support and postextubation support was provided by high-flow nasal cannula, respectively. A common use of high-flow nasal cannula was reported. The selection of first-line mode (high-flow nasal cannula or noninvasive ventilation) was markedly affected by PICU characteristics as well as patient age, primary diagnostic group, and admission type. High-flow nasal cannula failure, reported in 559 of 2,080 admissions (26.9%) when used for first-line support, was independently predicted by younger age, unplanned admission, and higher admission severity of illness.