Heated humidified high-flow nasal cannula therapy in children

Hutchings, Frances; Hilliard, Tom; Davis, Peter J.

doi:10.1136/archdischild-2014-306590

Cited by 77 publications

(75 citation statements)

References 34 publications

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“…High‐flow nasal cannula (HFNC) has been increasingly utilized in pediatric patients, due to its superiority in improving oxygenation over low flow oxygen therapy . It had similar efficacy to nasal continuous positive airway pressure (CPAP), especially when used as weaning support but better comfort and fewer complications, such as nasal trauma .…”

Section: Introductionmentioning

confidence: 99%

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Decrease the flow setting to improve trans‐nasal pulmonary aerosol delivery via “high‐flow nasal cannula” to infants and toddlers

Gong²,

Ari

et al. 2019

Pediatric Pulmonology

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Objectives Trans‐nasal pulmonary aerosol delivery for infants and toddlers has recently gained popularity, however, the reported lung deposition is low. We aimed to investigate the influential factors to improve the delivery. Methods Anatomic airway manikins simulating infant (5 kg) and toddler (15 kg) with collecting filter connected the trachea and breath simulator, were set to represent quiet and distressed breathing. Nasal cannula flow was set at 0.125, 0.25, 0.5, 1, and 2 L/kg/min. A mesh nebulizer (Aerogen) was placed at the inlet of humidifier (Fisher & Paykel) and proximal to patient. Albuterol (5 mg in 1 mL) was nebulized for each condition (n = 3). Drug was eluted from the filter and assayed with UV spectrophotometry (276 nm). Results Inhaled dose was higher with nebulizer placed at the inlet of humidifier than proximal to patient in all settings, except the infant model at low gas flow settings (0.125 and 0.25 L/kg/min). When nebulizer was placed at the inlet of humidifier, inhaled dose was higher when gas flow was below patient's inspiratory flow than when gas flow exceeded patient's inspiratory flow (8.77 ± 3.84 vs 2.16 ± 1.29%, P < 0.001); aerosol deposition increased as gas flow decreased, with greatest deposition at gas flow of 0.25 L/kg/min (11.29 ± 2.15%). A multiple linear regression identified gas flow as the primary predictor of aerosol delivery. Conclusions Trans‐nasal pulmonary aerosol delivery was significantly improved when gas flow was below patient's inspiratory flow, aerosol deposition increased with decreased nasal cannula flow, with greatest deposition at 0.25 L/kg/min.

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Section: Introductionmentioning

confidence: 99%

“…According to Ministry of Health in New South Wales, Australia, HFNC is considered as a bridge between low flow oxygen therapies and CPAP, in order to reduce the need for intubation . HFNC is recommended for pediatric bronchiolitis patients who have moderate to severe respiratory distress and failed to respond to low flow oxygen …”

Section: Introductionmentioning

confidence: 99%

Decrease the flow setting to improve trans‐nasal pulmonary aerosol delivery via “high‐flow nasal cannula” to infants and toddlers

Gong²,

Ari

et al. 2019

Pediatric Pulmonology

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“…HFNC delivers a heated and humidified air‐oxygen mixture with a flow rate over the patient's inspiratory flow. In this way, it provides removal of oxygen‐depleted gas in the nasopharyngeal dead space, reduction of carbon dioxide (CO 2 ) rebreathing, development of positive pharyngeal pressure, and positive end expiratory pressure, improvement of mucociliary clearance, and supports alveolar ventilation …”

Section: Introductionmentioning

confidence: 99%

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

Çağlar

Akgül

et al. 2018

Pediatric Pulmonology

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“…High‐flow nasal cannula (HFNC) has emerged as a means to deliver non‐invasive respiratory support and oxygen for acute respiratory distress in pediatrics . Delivering such therapy has been historically isolated to the pediatric intensive care unit (PICU) and represented very high admission rates.…”

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confidence: 99%

Pediatric early warning score and deteriorating ward patients on high‐flow therapy

Hansen

Hochman

Garner

et al. 2019

Pediatrics International

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Background Delivery of non‐invasive ventilation commonly occurs in the pediatric intensive care unit (PICU). With the advent of high‐flow nasal cannula (HFNC), patients with respiratory distress may be rescued on the ward without a PICU admission. We evaluated our ward HFNC algorithm to determine its safety profile and independent predictors for non‐responders, defined as requiring subsequent PICU admission. Methods A retrospective chart review of patients <17 years of age admitted with respiratory distress between 2016 and 2017 was carried out. Pediatric Early Warning System (PEWS) respiratory score was used to assess the clinical response of patients requiring HFNC. Variables associated with non‐responders were evaluated, and their PICU admission was studied for escalation of care and criticality. Results Patients with comorbidities (P = 0.02) were more likely to require HFNC. Of the 18 patients initiated on HFNC, 44% (n = 8) remained on the ward. Non‐responders (n = 10; 56%) had higher (2.7 vs 1.8; P = 0.03) and worsening (−0.1 vs 0.3; P = 0.05) PEWS respiratory scores 90 min after HFNC initiation. Eighty percent (n = 8) of non‐responders required escalation to continuous positive airway pressure or bilevel positive airway pressure in the PICU. For both HFNC responders and non‐responders, there were no requirements for intubation, evidence of air leak or difference in days of respiratory support. Conclusions High and worsening PEWS scores 90 min after HFNC initiation may indicate non‐response when coupled with a standardized ward HFNC algorithm for respiratory distress. Further improvements may be seen with an earlier initiation of HFNC in the emergency department and more aggressive flow escalation on the ward.

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Heated humidified high-flow nasal cannula therapy in children

Cited by 77 publications

References 34 publications

Decrease the flow setting to improve trans‐nasal pulmonary aerosol delivery via “high‐flow nasal cannula” to infants and toddlers

Decrease the flow setting to improve trans‐nasal pulmonary aerosol delivery via “high‐flow nasal cannula” to infants and toddlers

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

Pediatric early warning score and deteriorating ward patients on high‐flow therapy

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