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Use of high flow nasal cannula in critically ill infants, children, and adults: a critical review of the literature

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Abstract

Background

High flow nasal cannula (HFNC) systems utilize higher gas flow rates than standard nasal cannulae. The use of HFNC as a respiratory support modality is increasing in the infant, pediatric, and adult populations as an alternative to non-invasive positive pressure ventilation.

Objectives

This critical review aims to: (1) appraise available evidence with regard to the utility of HFNC in neonatal, pediatric, and adult patients; (2) review the physiology of HFNC; (3) describe available HFNC systems (online supplement); and (4) review ongoing and planned trials studying the utility of HFNC in various clinical settings.

Results

Clinical neonatal studies are limited to premature infants. Only a few pediatric studies have examined the use of HFNC, with most focusing on this modality for viral bronchiolitis. In critically ill adults, most studies have focused on acute respiratory parameters and short-term physiologic outcomes with limited investigations focusing on clinical outcomes such as duration of therapy and need for escalation of ventilatory support. Current evidence demonstrates that HFNC generates positive airway pressure in most circumstances; however, the predominant mechanism of action in relieving respiratory distress is not well established.

Conclusion

Current evidence suggests that HFNC is well tolerated and may be feasible in a subset of patients who require ventilatory support with non-invasive ventilation. However, HFNC has not been demonstrated to be equivalent or superior to non-invasive positive pressure ventilation, and further studies are needed to identify clinical indications for HFNC in patients with moderate to severe respiratory distress.

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Conflicts of interest

Dr. Cheifetz is a medical advisor to Philips-Respironics and Covidien.

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Authors and Affiliations

  1. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children’s Hospital, Durham, NC, USA

    Jan Hau Lee, Kyle J. Rehder, Ira M. Cheifetz & David A. Turner

  2. Duke Clinical Research Institute, Durham, NC, USA

    Jan Hau Lee

  3. Children’s Intensive Care Unit, Department of Pediatric Subspecialties, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore

    Jan Hau Lee

  4. Department of Respiratory Care Services, Duke University Medical Center, Durham, NC, USA

    Lee Williford & Ira M. Cheifetz

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Lee, J.H., Rehder, K.J., Williford, L. et al. Use of high flow nasal cannula in critically ill infants, children, and adults: a critical review of the literature. Intensive Care Med 39, 247–257 (2013). https://doi.org/10.1007/s00134-012-2743-5

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