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

Abstract

The use of the heated and humidified high-flow nasal cannula has become increasingly popular in the treatment of patients with respiratory failure through all age groups. 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). It is unclear which of the mechanisms of action is the most important, but it may depend on the cause of the patient’s respiratory failure. This article describes the mechanism of action in an easy to remember mnemonic (HIFLOW); Heated and humidified, meets Inspiratory demands, increases Functional residual capacity (FRC), Lighter, minimizes Oxygen dilution, and Washout of pharyngeal dead space. We will also examine some of the main indications for its use in both the adult and pediatric age groups. The data for the use of high-flow nasal cannula is growing, and currently, some of the main adult indications include hypoxemic respiratory failure due to pneumonia, post-extubation, pre-oxygenation prior to intubation, acute pulmonary edema, and use in patients who are "do not resuscitate or intubate". The main pediatric indication is in infants with bronchiolitis, but other indications are being studied, such as its use in asthma, croup, pneumonia, transport of a critically ill child, and post-extubation.

High-Flow Nasal Cannula: A Promising Oxygen Therapy for Patients with Severe Bronchial Asthma Complicated with Respiratory Failure

“…HFNC, as a novel oxygen therapy method, provides high-flow gas at the rate of 8-80 L/min through the air-oxygen mixing device, and the oxygen concentration of these gases can be set to 21%-100% according to the patient's needs, thus theoretically meeting the needs for improved oxygenation [25]. In addition, oxygen therapy using high-flow gas also ensures a high inspiratory flow rate in patients with bronchial asthma as well as stable oxygen delivery [6]. e efficacy of the COT method may be low due to insufficient oxygen content in the air; alternatively, the flow rate may not meet the needs of patients' conditions, and hence the effect of oxygen supply cannot be ensured [32].…”

“…Exclusion criteria were as follows: (1) immediate requirement of tracheal intubation; (2) myocardial infarction (cardiothoracic pain with electrocardiogram changes or increased levels of myocardial enzymes); (3) altered consciousness; (4) hemodynamic involvement (noninvasive blood pressure < 90/60 mmHg); (5) pregnancy in women; (6) respiratory rate (RR) > 45 breaths/min; (7) blood pH < 7.30; (8) untreated pneumothorax; (9) end-stage renal disease [estimated glomerular filtration rate (eGFR) < 15 mL/min per 1.73 m 2 or current dialysis]; (10) contraindications for positive-airway pressure devices; (11) pneumonia.…”

“…HFNC is a novel oxygen therapy developed in recent years, in which oxygen at a certain concentration mixed with highflow gas is directly delivered to patients through a nonsealed nasal cannula [6,7]. is oxygen therapy has been assessed by many studies and can be applied to patients with acute hypoxemic respiratory failure, status-post surgery, and respiratory failure without tracheal intubation, immunosuppression, and cardiac insufficiency, thus effectively improving oxygenation [8][9][10][11][12][13][14][15].…”

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

“…Indications from the evidence in adults include acute hypoxemic respiratory failure, postextubation support, preoxygenation before intubation or during bronchoscopy, postoperative respiratory failure, and acute pulmonary edema. 17) Many pediatric studies have included patients with acute bronchiolitis. However, other indications have been studied, including asthma, sleep apnea, pneumonia, transport of a critical patient, and postextubation respiratory support.…”

Evaluation of Patients Receiving High-flow Nasal Cannula Oxygenation Therapy in a Pediatric Intensive Care Unit

“…Bronşiolit dışında, çocuk hastalarda YANKO kullanımını destekleyen sınırlı veri vardır. Sınırlı da olsa yapılan çalışmalarda YANKO tedavisinin astım hastalarında, pnomonili hastalarda, entübasyon gereksiniminin azaltılmasında, ÇYBÜ yatış sıklığının azaltılmasında ve ekstübasyon sonrası dönemde etkili olabildiği gösterilmiştir (10). Yine YANKO üzerine yapılan çalışmalarda bronşiolit hastalığının yanısıra akciğer parankim hastalığı, nöromüskuler veya kardiyak sorunları olan hastaların da başarılı şekilde tedavi edilebildiği gösterilmiştir (11).…”