Use of high flow nasal cannula in critically ill infants, children, and adults: a critical review of the literature
- 8.5k Downloads
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.
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.
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.
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.
KeywordsHigh flow nasal cannula Non-invasive ventilation Gas exchange Hypoxia Respiratory distress Acute lung injury Acute respiratory distress syndrome
Conflicts of interest
Dr. Cheifetz is a medical advisor to Philips-Respironics and Covidien.
- 9.Wilkinson D, Andersen C, O’Donnell CP, De Paoli AG (2011) High flow nasal cannula for respiratory support in preterm infants. Cochrane Database Syst Rev CD006405Google Scholar
- 10.Nair G, Karna P (2005) Comparison of the effects of vapotherm and nasal CPAP in respiratory distress. PAS 57:2054. http://www.abstracts2view.com/pasall/view.php?nu=PAS5L1_1667
- 23.Kim IK, Phrampus E, Venkataraman S, Pitetti R, Saville A, Corcoran T, Gracely E, Funt N, Thompson A (2005) Helium/oxygen-driven albuterol nebulization in the treatment of children with moderate to severe asthma exacerbations: a randomized, controlled trial. Pediatrics 116:1127–1133PubMedCrossRefGoogle Scholar
- 30.Sztrymf B, Messika J, Mayot T, Lenglet H, Dreyfuss D, Ricard JD (2011) Impact of high-flow nasal cannula oxygen therapy on intensive care unit patients with acute respiratory failure: a prospective observational study. J Crit Care 27(3):324.e9–324.e13Google Scholar
- 34.Lenglet H, Sztrymf B, Leroy C, Brun P, Dreyfuss D, Ricard JD (2012) Humidified high flow nasal oxygen during respiratory failure in the emergency department: feasibility and efficacy. Respir care 57(11):1873–1878Google Scholar
- 35.Antonelli M, Conti G, Moro ML, Esquinas A, Gonzalez-Diaz G, Confalonieri M, Pelaia P, Principi T, Gregoretti C, Beltrame F, Pennisi MA, Arcangeli A, Proietti R, Passariello M, Meduri GU (2001) Predictors of failure of noninvasive positive pressure ventilation in patients with acute hypoxemic respiratory failure: a multi-center study. Intensive Care Med 27:1718–1728PubMedCrossRefGoogle Scholar
- 37.Antonelli M, Conti G, Esquinas A, Montini L, Maggiore SM, Bello G, Rocco M, Maviglia R, Pennisi MA, Gonzalez-Diaz G, Meduri GU (2007) A multiple-center survey on the use in clinical practice of noninvasive ventilation as a first-line intervention for acute respiratory distress syndrome. Crit Care Med 35:18–25PubMedCrossRefGoogle Scholar
- 38.Huang J, Fridman D (2011) High flow oxygen and low dose inhaled nitric oxide in a case of severe pulmonary hypertension and obstructive shock. Chest 140(4_Meeting Abstracts):63AGoogle Scholar
- 40.Atwood C, Miller T, McMillan N, Hartwig K, Camhi S, Schweikert H (2011) Effect of high flow highly humidified air via nasal cannula on respiratory effort in patients with advanced COPD. Chest 140(4_Meeting Abstracts):536AGoogle Scholar
- 58.United States National Institutes of Health (1993) ClinicalTrials.gov. http://clinicaltrials.gov/ct2/home
- 59.Australian New Zealand Clinical Trials Registry (2007). http://www.anzctr.org.au/
- 60.World Health Organization (2012) International Clinical Trials Registry Platform (ICTRP) Search Portal. http://apps.who.int/trialsearch/