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High Flow Nasal Cannula

High Flow Nasal Cannula

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Key Resources English (1) French All (1)

High-flow nasal cannula oxygen therapy in children

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Nagler J, Torrey SB, Wiley JF

This topic will focus on the use of high-flow nasal cannula (HFNC) in pediatric patients, including discussion of equipment, proposed mechanisms of action, comparison with other oxygen delivery devices, indications and contraindications, approach to initiation, assessment of effectiveness, and potential complications.

High-flow nasal cannula oxygen therapy in children

Visit

Nagler J, Torrey SB, Wiley JF

This topic will focus on the use of high-flow nasal cannula (HFNC) in pediatric patients, including discussion of equipment, proposed mechanisms of action, comparison with other oxygen delivery devices, indications and contraindications, approach to initiation, assessment of effectiveness, and potential complications.

Clinical pathways English (1) French All (1)

Use of high-flow nasal cannula oxygen therapy in infants and children

Visit

L Chauvin-Kimoff, A DeCaen,Canadian Paediatric Society

Heated, humidified high-flow nasal cannula (HHHFNC) therapy provides warmed, humidified oxygen to infants and children in respiratory distress at flow rates that deliver higher oxygen concentrations and some positive airway pressure compared with standard low-flow therapy. Increased use and experience is informing practice and establishing the benefits of HHHFNC use in a variety of clinical conditions. The focus of this practice point is to describe best practices for HHHFNC in (non-neonatal) paediatric patients with moderate-to-severe respiratory distress and to offer a safe, practical approach to oxygen delivery and support.

Use of high-flow nasal cannula oxygen therapy in infants and children

Visit

L Chauvin-Kimoff, A DeCaen,Canadian Paediatric Society

Heated, humidified high-flow nasal cannula (HHHFNC) therapy provides warmed, humidified oxygen to infants and children in respiratory distress at flow rates that deliver higher oxygen concentrations and some positive airway pressure compared with standard low-flow therapy. Increased use and experience is informing practice and establishing the benefits of HHHFNC use in a variety of clinical conditions. The focus of this practice point is to describe best practices for HHHFNC in (non-neonatal) paediatric patients with moderate-to-severe respiratory distress and to offer a safe, practical approach to oxygen delivery and support.

Clinical guidelines English (3) French All (3)

Guideline:Nasal High Flow Therapy

Visit

Children's Health Queensland Hospital and Health Service

The aim of this guideline is to ensure safe and effective use of Nasal High Flow (NHF) therapy for children with acute respiratory illness through: Appropriate placement in inpatient areas with trained staff. Support for decision making in relation to initiation, continuation and weaning of therapy and escalation of concerns.

Australasian bronchiolitis bedside clinical guideline

Visit

Sharon O'Brien et al on behalf of PREDICT Network Australasia

This guideline has been developed to provide an evidence-based clinical framework for the management of infants (012 months) with bronchiolitis treated in Australasian emergency departments (EDs) or general paediatric wards. Application of these guidelines for children over 12 months may be relevant but there is less diagnostic certainty in the 1224 month age group. (All references to age within this guideline refer to chronological age unless stated otherwise).

Humidified High Flow Nasal Cannula Oxygen Guideline for Metropolitan Paediatric Wards and EDs

Visit

NSW Government

This Guideline presents the current best evidence for Humidified High Flow Nasal Cannula Oxygen. Its purpose is to inform practice for clinicians in Metropolitan Level 4 Paediatric Units and Metropolitan Emergency Departments caring for infants and children who may benefit from Humidified High Flow Nasal Cannula Oxygen therapy.

Guideline:Nasal High Flow Therapy

Visit

Children's Health Queensland Hospital and Health Service

The aim of this guideline is to ensure safe and effective use of Nasal High Flow (NHF) therapy for children with acute respiratory illness through: Appropriate placement in inpatient areas with trained staff. Support for decision making in relation to initiation, continuation and weaning of therapy and escalation of concerns.

Australasian bronchiolitis bedside clinical guideline

Visit

Sharon O'Brien et al on behalf of PREDICT Network Australasia

This guideline has been developed to provide an evidence-based clinical framework for the management of infants (012 months) with bronchiolitis treated in Australasian emergency departments (EDs) or general paediatric wards. Application of these guidelines for children over 12 months may be relevant but there is less diagnostic certainty in the 1224 month age group. (All references to age within this guideline refer to chronological age unless stated otherwise).

Humidified High Flow Nasal Cannula Oxygen Guideline for Metropolitan Paediatric Wards and EDs

Visit

NSW Government

This Guideline presents the current best evidence for Humidified High Flow Nasal Cannula Oxygen. Its purpose is to inform practice for clinicians in Metropolitan Level 4 Paediatric Units and Metropolitan Emergency Departments caring for infants and children who may benefit from Humidified High Flow Nasal Cannula Oxygen therapy.

Systematic reviews English (4) French All (4)

High flow nasal cannula as respiratory support in treating infant bronchiolitis: a systematic review.

Visit

Moreel L, Proesmans M

In this review, we critically summarize the data from these RCTs with the aim to provide advice on how to position HFNC in clinical practice.Conclusion: HFNC is a safe mode of respiratory support that can be positioned between SOT and nCPAP as rescue therapy for children not adequately supported by SOT. It does not seem to shorten the duration of oxygen need nor the duration of hospital admission

High-flow nasal cannula therapy for children with bronchiolitis: a systematic review and meta-analysis.

Visit

Lin J, Zhang Y, Xiong L, Liu S, Gong C, Dai J.

To review the effects and safety of high-flow nasal cannula (HFNC) for bronchiolitis.

Efficacy of High-Flow Nasal Cannula vs Standard Oxygen Therapy or Nasal Continuous Positive Airway Pressure in Children with Respiratory Distress: A Meta-Analysis

Visit

Luo J, Duke T, Chisti MJ, Kepreotes E, Kalinowski V, Li J.

To evaluate the efficacy of high-flow nasal cannula (HFNC) oxygen therapy in providing respiratory support of children with acute lower respiratory infection (ALRI), hypoxemia, and respiratory distress.

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.

Visit

O'Brien S, Craig S, Babl FE, Borland ML, Oakley E, Dalziel SR; Paediatric Res...

Over the past decade, the use of high-flow nasal cannulae (HFNC) therapy has increased markedly and it is now utilised not only in the intensive care unit setting but in general paediatric wards and emergency departments. The aim of this systematic review was to summarise and critique the current evidence-base for the use of HFNC in infants with bronchiolitis.

High flow nasal cannula as respiratory support in treating infant bronchiolitis: a systematic review.

Visit

Moreel L, Proesmans M

In this review, we critically summarize the data from these RCTs with the aim to provide advice on how to position HFNC in clinical practice.Conclusion: HFNC is a safe mode of respiratory support that can be positioned between SOT and nCPAP as rescue therapy for children not adequately supported by SOT. It does not seem to shorten the duration of oxygen need nor the duration of hospital admission

High-flow nasal cannula therapy for children with bronchiolitis: a systematic review and meta-analysis.

Visit

Lin J, Zhang Y, Xiong L, Liu S, Gong C, Dai J.

To review the effects and safety of high-flow nasal cannula (HFNC) for bronchiolitis.

Efficacy of High-Flow Nasal Cannula vs Standard Oxygen Therapy or Nasal Continuous Positive Airway Pressure in Children with Respiratory Distress: A Meta-Analysis

Visit

Luo J, Duke T, Chisti MJ, Kepreotes E, Kalinowski V, Li J.

To evaluate the efficacy of high-flow nasal cannula (HFNC) oxygen therapy in providing respiratory support of children with acute lower respiratory infection (ALRI), hypoxemia, and respiratory distress.

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.

Visit

O'Brien S, Craig S, Babl FE, Borland ML, Oakley E, Dalziel SR; Paediatric Res...

Over the past decade, the use of high-flow nasal cannulae (HFNC) therapy has increased markedly and it is now utilised not only in the intensive care unit setting but in general paediatric wards and emergency departments. The aim of this systematic review was to summarise and critique the current evidence-base for the use of HFNC in infants with bronchiolitis.

Key studies English (16) French All (16)

Narrative review of practical aspects of aerosol delivery via high-flow nasal cannula.

Visit

Li J, Fink JB.

Using high-flow nasal cannula (HFNC) as a "vehicle" to administer aerosolized medication has attracted clinicians' interest in recent years. In this paper, we summarize the current evidence to answer the common questions raised by clinicians about this new aerosol delivery route and best practices of administration. Benefits of trans-nasal aerosol delivery include increased comfort, ability to speak, eat, and drink for patients while meeting a range of oxygen requirements, particularly for those who need to inhale aerosolized medication for long periods.

High flow nasal cannula and continuous positive airway pressure therapy in treatment of viral bronchiolitis: a randomized clinical trial.

Visit

Vahlkvist S, Jrgensen L, la Cour A, Markoew S, Petersen TH, Kofoed PE.

Continuous positive airway pressure (CPAP) has been used in infants with bronchiolitis for decades. Recently, high flow nasal cannula (HFNC) therapy was introduced. We conducted a trial of 50 children with bronchiolitis who were randomized to treatment with CPAP or HFNC. Objectives were to compare the development in respiratory rate, pCO2, and Modified Woods Clinical Asthma Score (M-WCAS) in young children with bronchiolitis, treated with CPAP or HFNC. Secondarily, to compare Neonatal Infant Pain Score (NIPS), treatment duration, treatment failure, and hospitalization length.

High-Flow Nasal Cannula vs. Continuous Positive Airway Pressure Therapy for the Treatment of Children <2 Years With Mild to Moderate Respiratory Failure Due to Pneumonia.

Visit

Liu C, Cheng WY, Li JS, Tang T, Tan PL, Yang L.

The aim of this prospective randomized controlled study was to further compare the clinical benefits and adverse reactions of HFNC with CPAP in the treatment of mild to moderate respiratory failure due to pneumonia in children below 2 years old. HFNC is an effective and safe initial respiratory support treatment in children <2 years with mild to moderate respiratory failure due to pneumonia, and the incidence of intubation and death is very low; concurrently, the comfort and tolerance of HFNC are better. To some extent, HFNC is a well-tolerated alternative to CPAP.

High-Flow Nasal Cannula Use Outside of the ICU Setting.

Visit

Kalburgi S, Halley T.

To describe the practice of high-flow nasal cannula (HFNC) use in the pediatric ward setting across North America. HFNC is used outside the ICU in nearly 50% of responding hospitals, with variation related to flow rate, feeding, and protocol use. HFNC is used for management of acute respiratory distress due to bronchiolitis, asthma, and pneumonia. Study findings suggest that HFNC is often used by pediatric hospitalists, but its use across North American hospitals remains variable and based on local consensus.

High-flow nasal cannula oxygen therapy in children: a clinical review.

Visit

Kwon JW.

High-flow nasal cannula (HFNC) is a relatively safe and effective noninvasive ventilation method that was recently accepted as a treatment option for acute respiratory support before endotracheal intubation or invasive ventilation. The action mechanism of HFNC includes a decrease in nasopharyngeal resistance, washout of dead space, reduction in inflow of ambient air, and an increase in airway pressure.

Safety of High-Flow Nasal Cannula Outside the ICU for Previously Healthy Children With Bronchiolitis.

Visit

Dadlez NM, Esteban-Cruciani N, Khan A, Shi Y, McKenna KJ, Azzarone G, et al.

High-flow nasal cannula (HFNC), a form of noninvasive respiratory support, is effective for the treatment of respiratory distress in ICUs. Although HFNC has been used outside of the ICU, there is little research that examines its safety in this less-monitored setting. HFNC may be a safe modality of respiratory support outside of the ICU for children ages 24 months with bronchiolitis and without comorbidities up to a maximum flow of 10 L/min. There were no adverse events among the subjects who were fed while on HFNC.

A two-tiered high-flow nasal cannula approach to bronchiolitis was associated with low admission rate to intensive care and no adverse outcomes.

Visit

Daverio M, Da Dalt L, Panozzo M, Frigo AC, Bressan S

We aimed to describe the characteristics and outcomes of infants with bronchiolitis who received high-flow nasal cannula oxygen (HFNC) following a two-tiered approach. A two-tiered approach to HFNC use in bronchiolitis was associated with low intensive care admissions and no adverse outcomes.

A Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitis.

Visit

Franklin D, Babl FE, Schlapbach LJ, Oakley E, Craig S, Neutze J, et al.

High-flow oxygen therapy through a nasal cannula has been increasingly used in infants with bronchiolitis, despite limited high-quality evidence of its efficacy. The efficacy of high-flow oxygen therapy through a nasal cannula in settings other than intensive care units (ICUs) is unclear. Among infants with bronchiolitis who were treated outside an ICU, those who received high-flow oxygen therapy had significantly lower rates of escalation of care due to treatment failure than those in the group that received standard oxygen therapy.

Early predictors of unresponsiveness to high-flow nasal cannula therapy in a pediatric emergency department.

Visit

Er A, alar A, Akgl F, Ulusoy E, itlenbik H, Ylmaz D, et al.

High-flow nasal cannula (HFNC) is a new treatment option for pediatric respiratory distress and we aimed to assess early predictive factors of unresponsiveness to HFNC therapy in a pediatric emergency department (ED). The low initial SpO2 and SF ratio, respiratory acidosis, and SF ratio less than 195 at the first hours of treatment were related to unresponsiveness to HFNC therapy in our pediatric emergency department.

High-flow Nasal Cannula: Mechanisms of Action and Adult and Pediatric Indications.

Visit

Lodeserto FJ, Lettich TM, Rezaie SR.

This article will examine the main mechanisms of actions attributed to the use of the high-flow nasal cannula and review the indications in adult and pediatric populations (outside of the neonatal period).

High flow nasal cannula in the emergency department: indications, safety and effectiveness.

Visit

Wang J, Lee KP, Chong SL, Loi M, Lee JH.

While there exists increasing enthusiasm in the use of HHHFNCT in the ED, constant monitoring of the patients and an experienced assessment of their response to treatment are critical and may require additional manpower deployment, which may be challenging, in the busy ED environment. Our experience with the use of HHHFNCT in children is still growing. Continual research in this area remains crucial in helping us better understand the patient types and conditions managed in ED that would most benefit from this device.

High-flow warm humidified oxygen versus standard low-flow nasal cannula oxygen for moderate bronchiolitis (HFWHO RCT): an open, phase 4, randomised controlled trial.

Visit

Kepreotes E, Whitehead B, Attia J, Oldmeadow C, Collison A, Searles A, et al.

We aimed to examine whether HFWHO provided enhanced respiratory support, thereby shortening time to weaning off oxygen. HFWHO did not significantly reduce time on oxygen compared with standard therapy, suggesting that early use of HFWHO does not modify the underlying disease process in moderately severe bronchiolitis. HFWHO might have a role as a rescue therapy to reduce the proportion of children requiring high-cost intensive care.

High flow nasal cannula (HFNC) versus nasal continuous positive airway pressure (nCPAP) for the initial respiratory management of acute viral bronchiolitis in young infants: a multicenter randomized controlled trial (TRAMONTANE study).

Visit

Milsi C, Essouri S, Pouyau R, Liet JM, Afanetti M, Portefaix A, et al.

Nasal continuous positive airway pressure (nCPAP) is currently the gold standard for respiratory support for moderate to severe acute viral bronchiolitis (AVB). Although oxygen delivery via high flow nasal cannula (HFNC) is increasingly used, evidence of its efficacy and safety is lacking in infants. In young infants with moderate to severe AVB, initial management with HFNC did not have a failure rate similar to that of nCPAP.

The use of high-flow nasal cannula in the pediatric emergency department.

Visit

Slain KN, Shein SL, Rotta AT.

To summarize the current literature describing high-flow nasal cannula use in children, the components and mechanisms of action of a high-flow nasal cannula system, the appropriate clinical applications, and its role in the pediatric emergency department. High-flow nasal cannula should be considered for pediatric emergency department patients with respiratory distress not requiring immediate endotracheal intubation; prospective, pediatric emergency department-specific trials are needed to better determine responsive patient populations, ideal high-flow nasal cannula settings, and comparative efficacy vs. other respiratory support modalities.

Is there a role for humidified heated high-flow nasal cannula therapy in paediatric emergency departments?

Visit

Long E, Babl FE, Duke T.

We introduced HFNC therapy into a paediatric ED and evaluated its use and failure rates. HFNC therapy may have a role in the paediatric ED as an easily administered and well tolerated form of non-invasive respiratory support, but about one-third of patients required escalation to a higher level of respiratory support. Further studies should assess the safety profile of HFNC in larger series, and define the role of HFNC in key respiratory conditions compared with other possible interventions.

Use of high-flow nasal cannula support in the emergency department reduces the need for intubation in pediatric acute respiratory insufficiency.

Visit

Wing R, James C, Maranda LS, Armsby CC.

The objective of this study was to determine whether the use of heated, humidified, high-flow nasal cannula (HFNC) therapy is associated with a decreased need for intubation in patients presenting to a pediatric emergency department (PED) and admitted to a pediatric intensive care unit (PICU) with acute respiratory insufficiency (ARI). High-flow nasal cannula used early in the development of pediatric ARI is associated with a decreased the need for intubation and mechanical ventilation.

Narrative review of practical aspects of aerosol delivery via high-flow nasal cannula.

Visit

Li J, Fink JB.

Using high-flow nasal cannula (HFNC) as a "vehicle" to administer aerosolized medication has attracted clinicians' interest in recent years. In this paper, we summarize the current evidence to answer the common questions raised by clinicians about this new aerosol delivery route and best practices of administration. Benefits of trans-nasal aerosol delivery include increased comfort, ability to speak, eat, and drink for patients while meeting a range of oxygen requirements, particularly for those who need to inhale aerosolized medication for long periods.

High flow nasal cannula and continuous positive airway pressure therapy in treatment of viral bronchiolitis: a randomized clinical trial.

Visit

Vahlkvist S, Jrgensen L, la Cour A, Markoew S, Petersen TH, Kofoed PE.

Continuous positive airway pressure (CPAP) has been used in infants with bronchiolitis for decades. Recently, high flow nasal cannula (HFNC) therapy was introduced. We conducted a trial of 50 children with bronchiolitis who were randomized to treatment with CPAP or HFNC. Objectives were to compare the development in respiratory rate, pCO2, and Modified Woods Clinical Asthma Score (M-WCAS) in young children with bronchiolitis, treated with CPAP or HFNC. Secondarily, to compare Neonatal Infant Pain Score (NIPS), treatment duration, treatment failure, and hospitalization length.

High-Flow Nasal Cannula vs. Continuous Positive Airway Pressure Therapy for the Treatment of Children <2 Years With Mild to Moderate Respiratory Failure Due to Pneumonia.

Visit

Liu C, Cheng WY, Li JS, Tang T, Tan PL, Yang L.

The aim of this prospective randomized controlled study was to further compare the clinical benefits and adverse reactions of HFNC with CPAP in the treatment of mild to moderate respiratory failure due to pneumonia in children below 2 years old. HFNC is an effective and safe initial respiratory support treatment in children <2 years with mild to moderate respiratory failure due to pneumonia, and the incidence of intubation and death is very low; concurrently, the comfort and tolerance of HFNC are better. To some extent, HFNC is a well-tolerated alternative to CPAP.

High-Flow Nasal Cannula Use Outside of the ICU Setting.

Visit

Kalburgi S, Halley T.

To describe the practice of high-flow nasal cannula (HFNC) use in the pediatric ward setting across North America. HFNC is used outside the ICU in nearly 50% of responding hospitals, with variation related to flow rate, feeding, and protocol use. HFNC is used for management of acute respiratory distress due to bronchiolitis, asthma, and pneumonia. Study findings suggest that HFNC is often used by pediatric hospitalists, but its use across North American hospitals remains variable and based on local consensus.

High-flow nasal cannula oxygen therapy in children: a clinical review.

Visit

Kwon JW.

High-flow nasal cannula (HFNC) is a relatively safe and effective noninvasive ventilation method that was recently accepted as a treatment option for acute respiratory support before endotracheal intubation or invasive ventilation. The action mechanism of HFNC includes a decrease in nasopharyngeal resistance, washout of dead space, reduction in inflow of ambient air, and an increase in airway pressure.

Safety of High-Flow Nasal Cannula Outside the ICU for Previously Healthy Children With Bronchiolitis.

Visit

Dadlez NM, Esteban-Cruciani N, Khan A, Shi Y, McKenna KJ, Azzarone G, et al.

High-flow nasal cannula (HFNC), a form of noninvasive respiratory support, is effective for the treatment of respiratory distress in ICUs. Although HFNC has been used outside of the ICU, there is little research that examines its safety in this less-monitored setting. HFNC may be a safe modality of respiratory support outside of the ICU for children ages 24 months with bronchiolitis and without comorbidities up to a maximum flow of 10 L/min. There were no adverse events among the subjects who were fed while on HFNC.

A two-tiered high-flow nasal cannula approach to bronchiolitis was associated with low admission rate to intensive care and no adverse outcomes.

Visit

Daverio M, Da Dalt L, Panozzo M, Frigo AC, Bressan S

We aimed to describe the characteristics and outcomes of infants with bronchiolitis who received high-flow nasal cannula oxygen (HFNC) following a two-tiered approach. A two-tiered approach to HFNC use in bronchiolitis was associated with low intensive care admissions and no adverse outcomes.

A Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitis.

Visit

Franklin D, Babl FE, Schlapbach LJ, Oakley E, Craig S, Neutze J, et al.

High-flow oxygen therapy through a nasal cannula has been increasingly used in infants with bronchiolitis, despite limited high-quality evidence of its efficacy. The efficacy of high-flow oxygen therapy through a nasal cannula in settings other than intensive care units (ICUs) is unclear. Among infants with bronchiolitis who were treated outside an ICU, those who received high-flow oxygen therapy had significantly lower rates of escalation of care due to treatment failure than those in the group that received standard oxygen therapy.

Early predictors of unresponsiveness to high-flow nasal cannula therapy in a pediatric emergency department.

Visit

Er A, alar A, Akgl F, Ulusoy E, itlenbik H, Ylmaz D, et al.

High-flow nasal cannula (HFNC) is a new treatment option for pediatric respiratory distress and we aimed to assess early predictive factors of unresponsiveness to HFNC therapy in a pediatric emergency department (ED). The low initial SpO2 and SF ratio, respiratory acidosis, and SF ratio less than 195 at the first hours of treatment were related to unresponsiveness to HFNC therapy in our pediatric emergency department.

High-flow Nasal Cannula: Mechanisms of Action and Adult and Pediatric Indications.

Visit

Lodeserto FJ, Lettich TM, Rezaie SR.

This article will examine the main mechanisms of actions attributed to the use of the high-flow nasal cannula and review the indications in adult and pediatric populations (outside of the neonatal period).

High flow nasal cannula in the emergency department: indications, safety and effectiveness.

Visit

Wang J, Lee KP, Chong SL, Loi M, Lee JH.

While there exists increasing enthusiasm in the use of HHHFNCT in the ED, constant monitoring of the patients and an experienced assessment of their response to treatment are critical and may require additional manpower deployment, which may be challenging, in the busy ED environment. Our experience with the use of HHHFNCT in children is still growing. Continual research in this area remains crucial in helping us better understand the patient types and conditions managed in ED that would most benefit from this device.

High-flow warm humidified oxygen versus standard low-flow nasal cannula oxygen for moderate bronchiolitis (HFWHO RCT): an open, phase 4, randomised controlled trial.

Visit

Kepreotes E, Whitehead B, Attia J, Oldmeadow C, Collison A, Searles A, et al.

We aimed to examine whether HFWHO provided enhanced respiratory support, thereby shortening time to weaning off oxygen. HFWHO did not significantly reduce time on oxygen compared with standard therapy, suggesting that early use of HFWHO does not modify the underlying disease process in moderately severe bronchiolitis. HFWHO might have a role as a rescue therapy to reduce the proportion of children requiring high-cost intensive care.

High flow nasal cannula (HFNC) versus nasal continuous positive airway pressure (nCPAP) for the initial respiratory management of acute viral bronchiolitis in young infants: a multicenter randomized controlled trial (TRAMONTANE study).

Visit

Milsi C, Essouri S, Pouyau R, Liet JM, Afanetti M, Portefaix A, et al.

Nasal continuous positive airway pressure (nCPAP) is currently the gold standard for respiratory support for moderate to severe acute viral bronchiolitis (AVB). Although oxygen delivery via high flow nasal cannula (HFNC) is increasingly used, evidence of its efficacy and safety is lacking in infants. In young infants with moderate to severe AVB, initial management with HFNC did not have a failure rate similar to that of nCPAP.

The use of high-flow nasal cannula in the pediatric emergency department.

Visit

Slain KN, Shein SL, Rotta AT.

To summarize the current literature describing high-flow nasal cannula use in children, the components and mechanisms of action of a high-flow nasal cannula system, the appropriate clinical applications, and its role in the pediatric emergency department. High-flow nasal cannula should be considered for pediatric emergency department patients with respiratory distress not requiring immediate endotracheal intubation; prospective, pediatric emergency department-specific trials are needed to better determine responsive patient populations, ideal high-flow nasal cannula settings, and comparative efficacy vs. other respiratory support modalities.

Is there a role for humidified heated high-flow nasal cannula therapy in paediatric emergency departments?

Visit

Long E, Babl FE, Duke T.

We introduced HFNC therapy into a paediatric ED and evaluated its use and failure rates. HFNC therapy may have a role in the paediatric ED as an easily administered and well tolerated form of non-invasive respiratory support, but about one-third of patients required escalation to a higher level of respiratory support. Further studies should assess the safety profile of HFNC in larger series, and define the role of HFNC in key respiratory conditions compared with other possible interventions.

Use of high-flow nasal cannula support in the emergency department reduces the need for intubation in pediatric acute respiratory insufficiency.

Visit

Wing R, James C, Maranda LS, Armsby CC.

The objective of this study was to determine whether the use of heated, humidified, high-flow nasal cannula (HFNC) therapy is associated with a decreased need for intubation in patients presenting to a pediatric emergency department (PED) and admitted to a pediatric intensive care unit (PICU) with acute respiratory insufficiency (ARI). High-flow nasal cannula used early in the development of pediatric ARI is associated with a decreased the need for intubation and mechanical ventilation.