Factors contributing to the failure of humidified high‐flow nasal cannulae

Teoh, Sophia; Clyde, Elizabeth; Dassios, Theodore; Greenough, Anne

doi:10.1111/apa.14415

Cited by 2 publications

(2 citation statements)

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“…In all of these studies a dedicated high frequency ventilator was employed to deliver oscillatory pressures in combination with either conventional IMV breaths or positive distending pressures such as NCPAP or NIPPV. In infants for whom HFNC treatment failure is predicted or commonly known to occur, such as infants <30 weeks gestation and receiving an initial FiO 2 > 0.30, as suggested by Teoh et al as well as by Manley et al, HFNC with flow oscillation may be a viable option prior to NCPAP or re‐intubation. Nonetheless, besides choosing an appropriate respiratory support mode, other important factors also need to be considered when deciding on the support criteria.…”

Section: Discussionmentioning

confidence: 94%

“…In contrast, HFNC been found to be inferior to NCPAP in two recent randomized non‐inferiority trials . In cases of HFNC treatment failure, infants are routinely either transitioned to NCPAP therapy or, if necessary, intubated . Working toward improved management of HFNC therapy, guidelines have recently been published in which a consensus approach was used to optimize HFNC treatment criteria regarding factors such as initiation, escalation, and weaning …”

Section: Introductionmentioning

confidence: 99%

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Effect of high frequency oscillatory high flow nasal cannula on carbon dioxide clearance in a premature infant lung model: A bench study

Sivieri

Eichenwald

Bakri

et al. 2018

Pediatric Pulmonology

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Objective: This study compared CO 2 clearance in a premature infant lung model connected to a high flow nasal cannula (HFNC) system supplied with oscillatory versus non-oscillatory flow.Design/Methods: The lung model was set to compliance 1.0 mL/cmH 2 O, RR 60 breaths/min, and 6 mL tidal volume. A 100% CO 2 was injected at a constant 15 mL/min.To create oscillation, HFNC flow was interrupted at rates of 4-6-8 and 10 Hz. equilibrated end-tidal CO 2 (ETCO 2 ) was recorded with and without oscillation at set flows of 2-8 L/min and repeated for each oscillation frequency.Results: Overall ETCO 2 decreased significantly (P < 0.001) during both non-oscillatory and oscillatory HFNC as set flow increased from 2 to 8 L/min by 26.3% and 60.8%, respectively. Oscillatory ETCO 2 levels decreased linearly compared to non-oscillatory HFNC with negligible difference at 2 L/min and a 48.4% difference at 8 L/min (P < 0.001). There were no differences in ETCO 2 levels between oscillation frequencies at any flow except at 6 Hz for which ETCO 2 was significantly lower (P < 0.01) than at 4, 8, and 10 Hz for 5-8 L/min HFNC flows. Amplitude of volume oscillations increased with increasing flow from 0.5 mL at 2 L/min to 4.0 mL at 8 L/min (P < 0.001), and decreased with increasing oscillation frequency.Conclusion: Oscillatory HFNC as compared to non-oscillatory was associated with significantly improved CO 2 clearance in this premature infant lung model. This simple modification of the HFNC system may prove to be a useful enhancement to this mode of non-invasive respiratory support for preterm infants at high risk for respiratory failure. K E Y W O R D S CO 2 clearance, HFNC, high frequency ventilation, non-invasive respiratory support, premature infants

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%