Research in high flow therapy: Mechanisms of action

Dysart, Kevin; Miller, Thomas L.; Wolfson, Marla R.; Shaffer, Thomas H.

doi:10.1016/j.rmed.2009.04.007

Cited by 640 publications

(541 citation statements)

References 35 publications

Supporting

Mentioning

514

Contrasting

Unclassified

Order By: Relevance

“…69 Even though CPAP also uses warmed, humidified gas, an in vivo study revealed that the humidity of gas delivered by HFNC was significantly greater. 37 It is uncertain whether the increased humidity delivered by HFNC is clinically important.…”

Section: Physiologic Principlesmentioning

confidence: 99%

Noninvasive Respiratory Support

Polin¹,

Watterberg²,

Cummings³

et al. 2016

Pediatrics

View full text Add to dashboard Cite

Mechanical ventilation is associated with increased survival of preterm infants but is also associated with an increased incidence of chronic lung disease (bronchopulmonary dysplasia) in survivors. Nasal continuous positive airway pressure (nCPAP) is a form of noninvasive ventilation that reduces the need for mechanical ventilation and decreases the combined outcome of death or bronchopulmonary dysplasia. Other modes of noninvasive ventilation, including nasal intermittent positive pressure ventilation, biphasic positive airway pressure, and high-fl ow nasal cannula, have recently been introduced into the NICU setting as potential alternatives to mechanical ventilation or nCPAP. Randomized controlled trials suggest that these newer modalities may be effective alternatives to nCPAP and may offer some advantages over nCPAP, but effi cacy and safety data are limited.

show abstract

Section: Physiologic Principlesmentioning

confidence: 99%

Noninvasive Respiratory Support

Polin¹,

Watterberg²,

Cummings³

et al. 2016

Pediatrics

View full text Add to dashboard Cite

show abstract

“…9,53 Extrathoracic anatomic dead space is related to age and is higher in small infants (.3 mL/kg) compared with adults. 54 Thus, continuous washout of this relatively large space with a supply of fresh gas could be of clinical benefit, especially in the neonatal period.…”

Section: Figurementioning

confidence: 99%

Safety and Efficacy of High-Flow Nasal Cannula Therapy in Preterm Infants: A Meta-analysis

et al. 2015

View full text Add to dashboard Cite

BACKGROUND AND OBJECTIVE: High-flow therapy is the most recent, and popular, mode of respiratory support in neonates. However, the evidence supporting its efficacy and safety has not yet been established. We conducted a systematic review and meta-analysis of clinical trials comparing efficacy and safety of high-flow therapy compared with other modes of noninvasive ventilation (NIV) in preterm infants.METHODS: Articles were indexed by using Medline, Embase, Scopus, OpenSIGLE, Health Management Information Consortium, and Cochrane Central Register of Controlled Trials. Randomized or quasirandomized clinical trials involving preterm infants, comparing high-flow therapy with other modes of NIV, and reporting extractable data on relevant outcomes, were selected. Data on efficacy, safety, and other common neonatal outcomes were extracted on predesigned forms. RESULTS:In this analysis, we included 1112 preterm infants, participating in 9 clinical trials. High-flow therapy was similar in efficacy to other modes of NIV in preterm infants when used as primary support (odds ratio of failure of therapy, 1.02 [95% confidence interval: 0.55 to 1.88]), as well as after extubation (1.09 [0.58 to 2.02]). There were no significant differences in odds of death (0.48 [0.18 to 1.24]) between the groups. Preterm infants supported on highflow had significantly lower odds of nasal trauma (0.13 [0.02 to 0.69]).CONCLUSIONS: High-flow therapy appears to be similar in efficacy and safety to other conventional modes of NIV in preterm infants. It is associated with significantly lower odds of nasal trauma. Caution needs to be exercised in extreme preterm infants because of the paucity of published data.

show abstract

“…In addition to washout of the pharyngeal dead space, decrease in inspiratory resistance, and supply of adequately warmed and humidified gas, HFNC has been shown to provide low levels of positive airway pressure, which is suspected to contribute to improving oxygenation and decreasing breathing effort. [22][23][24] Despite this physiological evidence, there are limited published studies on HFNC use in adults with ARF. Roca et al 25 were the first to show the clinical benefit of HFNC in ARF by presenting significant improvement in both clinical and physiological parameters after 30 min of HFNC compared with face-mask oxygen therapy.…”

Section: Discussionmentioning

confidence: 99%