Use of heated humidified high‐flow nasal cannula oxygen in neonates: a <scp>UK</scp> wide survey

Ojha, Shalini; Gridley, Eleanor; Dorling, Jon

doi:10.1111/apa.12090

Cited by 86 publications

(76 citation statements)

References 24 publications

(32 reference statements)

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“…The most recent mode of respiratory support to be introduced for newborn infants, HHHFNC, however, has quickly gained popularity among clinicians worldwide, [9][10][11][12][13] although evidence supporting its use is not fully established. [14][15][16] Several clinical trials over the last decade have collected evidence of the use of HHHFNC in preterm infants, both as a primary mode of support at birth and after extubation from MV.…”

mentioning

confidence: 99%

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

et al. 2015

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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.

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mentioning

confidence: 99%

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

et al. 2015

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“…Surveys revealed that between 50 and 77% of units were using it [25,29,30]. The most common indication was in the immediate post-extubation period.…”

Section: Noninvasive Ventilationmentioning

confidence: 99%

“…With regard to the actual delivery of HFNC, current evidence (from the literature and manufacturers) recommends using no more than 8 L of flow and a nasal cannula that allow some degree of leakage around the nares (around 50%). In spite of this, there is wide variability in HFNC delivery; one survey reported that as many as 15% use maximal flows greater than 8 L, over half of the respondents apply nasal cannula that exactly fits the nostrils and 23% apply measures to keep the mouth closed [29]. All these actions have the potential to deliver unreliable and dangerously high levels of pressure.…”

Section: Noninvasive Ventilationmentioning

confidence: 99%

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Respiratory Care Protocols in Neonatal Intensive Care

Shalish¹,

Anna²

2016

Respiratory Management of Newborns

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Neonatal respiratory care involves physicians with variable backgrounds treating multiple respiratory problems and populations with a number of invasive and noninvasive devices and strategies. Unfortunately, there is a lack of strong evidence to guide the most adequate management for several specific situations. Altogether, this complexity leads to significant practice variability that can affect patient and health care outcomes. Respiratory care protocols, guided by evidence and/or consensus, are an attractive solution to promote standardization of care and reduction of unnecessary practice variations. Indeed, despite the limited evidence supporting the use of respiratory protocols in neonates, a significant number of units have already developed and implemented them into clinical practice. Respiratory care protocols appear to promote evidence-based practices, discourage outdated approaches and ultimately improve patient safety.

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“…Critically ill patients suffering from COPD benefit from nasal high flow (NHF) therapy, which is the administration of warmed and humidified air at flow rates up to 8 L/min in neonates [5][6][7] and 60 L/min in adults [8]. NHF reduces the physiological dead space and respiratory frequency, and improves gas exchange [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Effect of variation in the COPD breathing flow pattern on end-tidal CO2 tension: An in vitro study

Adams¹,

Jermy²,

Geoghegan³

et al. 2017

Med Clin Arch

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Aim: The goal of this work was to find out if the variation in breathing flow pattern alone (without change in tidal volume and respiratory rate) changes the end-tidal CO 2 tension (EtCO 2 ) enough to affect the health of a patient. The influence of I:E ratio on EtCO 2 was also investigated. Method:Four breathing flow patterns belonging to different individuals diagnosed with COPD were collected from the literature. These were scaled to the same tidal volume, respiratory rate and I:E ratio, leaving shape as the only varying parameter. A programmable piston pump was used to reproduce the breathing flow patterns in an anatomically correct adult upper airway model (3D printed in acrylic, Visijet Ex200). CO 2 was simultaneously bled into the pump chamber at steady rate to mimic metabolic CO 2 production, followed by the measurement of EtCO 2 with and without 30 L/min of nasal high flow therapy. Results:Breathing flow patterns varying in shape but not in tidal volume, respiratory rate and I:E ratio can produce statistically significant differences in EtCO 2 . The variability in EtCO 2 was however found to be small (1 -2%) and unlikely to be physiologically relevant. A 35% fall in I:E ratio corresponded to a 2% rise in EtCO 2 . 30 L/min of NHF reduced EtCO 2 by approximately 20%. Conclusion:Shape alone can cause a statistically significant difference in EtCO 2 however the difference in EtCO 2 is small. A 35% reduction in I:E ratio results in a 2% rise in EtCO 2 .

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Use of heated humidified high‐flow nasal cannula oxygen in neonates: a UK wide survey

Cited by 86 publications

References 24 publications

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

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

Respiratory Care Protocols in Neonatal Intensive Care

Effect of variation in the COPD breathing flow pattern on end-tidal CO2 tension: An in vitro study

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