Indications and outcome of home high‐flow nasal therapy in children, a single‐center experience

Abstract

High‐flow nasal therapy (HFNT) is a safe and simple way to deliver humidified air and oxygen for respiratory support in infants and children. HFNT is well established in an inpatient setting, but home HFNT lacks evidence. In the current study, we studied characteristics and outcomes of pediatric patients with home HFNT. In a monocentric retrospective analysis of data for 10 years (April 2010–April 2020), patient characteristics from the time point of the first discharge from hospital with home HFNT‐treatment and the subsequent course were analyzed. Patients were divided into three HFNT indication groups: (1) bronchopulmonary dysplasia (BPD), (2) upper airway obstruction (UAO), and (3) other indications. Forty patients received home HFNT in the study period. Seventeen patients were treated for BPD, 15 for UAO, and 8 had other indications. Twenty‐two patients (55%) were successfully weaned from HFNT (12 [70.6%] BPD, 7 [46.7%] UAO, 3 [37.5%] other), while seven patients (17.5%) died during follow‐up (4 BPD, 2 UAO, 1 other). Twenty‐three patients (57.5%) required (intermittent) additional oxygen application (14 [82.4%] BPD, 6 [40%] UAO, 4 [50%] other). Weaning success and need for additional oxygen were significantly more probable in BPD patients compared to the UOA group. In conclusion, HFNT plays an increasing role in home treatment of respiratory insufficiency of various etiologies in childhood. It often represents a temporary intervention, especially for children with BPD but might also serve as long‐term treatment for children in whom other forms of ventilatory support are not feasible or desired.

Respiratory support strategies in the prevention and treatment of bronchopulmonary dysplasia

“…In one small case series, 12/17 (71%) patients with BPD discharged using HFNC were able to successfully wean to room air after an average of about 6 months. However, 4/17 (24%) of these patients died prior to weaning from support, which is much higher than demonstrated in other cohorts of patients with severe BPD (89,90). Because of the high rates of mortality following discharge, home HFNC should be considered with extreme…”

Two Extremely Preterm Infants Discharged with a Home High‐Flow Nasal Cannula for Severe Bronchopulmonary Dysplasia

“…Therefore, there have only been a few clinical reports of home HFNC implementation [ 1 , 2 ], which is why we included a device with both nCPAP and HFNC settings. To our knowledge, only one study has reported home HFNC use in cases of BPD [ 6 ]. However, while that report described several cases of BPD with a home HFNC, salient details, such as the clinical course of the patients, indications for use, and issues with home HFNC use, were lacking.…”