Glass half empty or half full? The story of high-flow nasal cannula therapy in critically ill children

Ramnarayan, Padmanabhan; Schibler, Andreas

doi:10.1007/s00134-016-4663-2

Cited by 33 publications

(30 citation statements)

References 16 publications

(15 reference statements)

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“…NHF supports the inspiratory effort if the inspiratory flow demand is matched, whereas CPAP should maintain a constant positive airway pressure during the inspiratory and expiratory phase. Our measured inspiratory pressures were much less than the delivered pressures and we found large variations in oesophageal pressure measurements, and therefore the limited capability to predict continuous distending pressure …”

Section: Discussionmentioning

confidence: 99%

“…Oxygenation was significantly better on BCPAP than on NHF, particularly at 2 L/min, a significant finding considering that oxygen free radicals are implicated in chronic lung disease, retinopathy of prematurity, necrotizing enterocolitis, and periventricular leukomalacia. 33 NHF supports the inspiratory effort if the inspiratory flow demand is matched, 34,35 whereas CPAP should maintain a constant positive airway pressure during the inspiratory and expiratory phase.…”

Section: T a B L E 1 Demographics Of Included Infantsmentioning

confidence: 99%

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Effect of randomization of nasal high flow rate in preterm infants

Hough

Shearman

Jardine

et al. 2019

Pediatric Pulmonology

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Objective To assess the effect of nasal high flow (NHF) cannula on end‐expiratory level (EEL), continuous distending pressure (CDP) and regional ventilation distribution in preterm infants. Design A prospective observational clinical study with randomly applied NHF rates. Patients and Setting Preterm infants requiring continuous positive airway pressure (CPAP) respiratory support in a Neonatal Intensive Care Unit. Interventions Infants were measured on randomly applied flow rates at 2, 4, and 6 L/min of NHF and compared with bubble CPAP. Measurements and Results Regional ventilation distribution and EEL were measured using electrical impedance tomography (EIT) and respiratory inductance plethysmography (RIP) in 24 preterm infants (31.19 ± 1.17 weeks corrected age). Changes in CDP were measured from the esophagus via the nasogastric tube. Physiological variables were also recorded. There were no differences in ventilation distribution, EEL or CDP between CPAP and NHF (P > .05). However, the physiological variables of FiO2 (P = .01) and SpO2/FiO2 (P < .01) were improved on CPAP compared with NHF. Conclusion NHF applied in random order with flow rates between 2 to 6 L/min was equally as good as CPAP in maintaining EEL and ventilation distribution in stable preterm infants. Overall oxygenation was better on CPAP compared to NHF.

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Section: Discussionmentioning

confidence: 99%

Section: T a B L E 1 Demographics Of Included Infantsmentioning

confidence: 99%

Effect of randomization of nasal high flow rate in preterm infants

Hough

Shearman

Jardine

et al. 2019

Pediatric Pulmonology

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“…bronchiolitis-focused [4] with debatable interpretations [1,5]. The current use of HHFNC in infants and children, therefore, is still largely based on individual experience with a clear lack of national and international guidance.…”

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confidence: 99%

“…The primary mechanism of action for HHFNC is not well known but has many theoretical ones by which it reduces the work of breathing and improves efficiency of ventilation [6,7] by washing out the nasopharyngeal dead space leading to improved alveolar ventilation, reduction in the inspiratory resistance associated with the nasopharynx, improvement in conductance and pulmonary compliance by supplying adequately warmed and humidified gas and provision of positive distending pressure for lung recruitment although the latest is variable [1,8]. Optimal starting flow rate, strategies for weaning, feeding, and use of adjunctive therapy such as nebuliser therapy are some of the unanswered questions while applying HHFNC [9].…”

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confidence: 99%

A nationwide survey on the use of heated humidified high flow oxygen therapy on the paediatric wards in the UK: current practice and research priorities

2020

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Background: Heated Humidified High Flow Nasal Cannula Oxygen Therapy (HHFNC) is increasingly used on the paediatric wards and High Dependency Units (HDU) for different types of pathologies and different age groups. We aimed to describe current practice related to the use of HHFNC on the paediatric wards and HDUs, weaning practices and preferred outcome measures for future research. Methods: We carried out a cross-sectional online survey of UK paediatric consultants or their delegates working on the paediatric wards. Descriptive analysis of their geographical, and organizational characteristics, their specialties, and their level of experience was investigated. Reasons for HHFNC initiation, weaning criteria, patients' characteristics and their primary pathologies were also analysed. Results: Participation of 218 paediatricians from 81 hospitals (Median: 2.7, Range: 1-11) was registered. HHFNC was provided in most of the surveyed hospitals (93%, 75/81). A High Dependency Unit (HDU) was available in 47 hospitals (58%); less than a third of those have a dedicated paediatrician. Decisions around HHFNC were made solely by paediatricians in (75%) of the cases, mostly at hospitals with no HDU compared to those with dedicated HDUs (70.3% VS 36.6, 95%CI:22.6-50.4%, P < .001). HHFNC was reported by nearly two-thirds (68%) of the practitioners who used it on the wards to be as effective or superior to CPAP (Continuous Positive Airway Pressure) with fewer complications. Failure rate while on HHFNC was identified as the most important outcome measure in any future research followed by the length of need for HHFNC support (37.1, and 28% respectively). Conclusion: This survey showed support for developing paediatric-specific national guidance on the use of HHFNC on the wards. Our list of defined research priorities may help guide further collaborative research efforts in this field.

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“…On a practical level, HFNC efficacy in cases of respiratory failure depends on matching the patient's inspiratory demand with the delivered flow rate (8). In normally breathing neonates and infants, data on peak tidal inspiratory flow are very scarce, possibly ranging between 0.83 and 2.5 L/kg/min (9,10).…”

mentioning

confidence: 99%