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EditorialEditorials

High-Flow Nasal Cannula in the Pediatric ICU: Popular or Efficient?

Florent Baudin and Robin Pouyau
Respiratory Care August 2017, 62 (8) 1116-1117; DOI: https://doi.org/10.4187/respcare.05720
Florent Baudin
Réanimation Pédiatrique Hôpital Femme Mère Enfant Hospices Civils de Lyon Bron, France Université Claude Bernard Lyon 1 Lyon, France
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  • For correspondence: [email protected]
Robin Pouyau
Réanimation Pédiatrique Hôpital Femme Mère Enfant Hospices Civils de Lyon Bron, France
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High-flow nasal cannula (HFNC) delivers a heated and humidified gas mixture at a flow greater than patient inspiratory flow demand. Several physiological studies have evaluated HFNC in neonates, infants, children, and adults. These found that HFNC improves gas exchange, applies positive pressure, flushes anatomical dead space, and decreases work of breathing.1,2 In adults, the FLORALI trial3 was the first to provide evidence of HFNC superiority over noninvasive ventilation (NIV) and standard oxygenation, which places the HFNC as the primary respiratory support for adults with hypoxemic acute respiratory failure.4

HFNC is noninvasive respiratory support that is a simple and well-tolerated alternative to other forms of support, such as CPAP and NIV. In this issue of Respiratory Care, Coletti et al5 report their experience using HFNC in 620 children over 2 y, representing more than a quarter of children admitted to the pediatric ICU. HFNC was initiated as the first line therapy for various diseases (eg, asthma, bronchiolitis, pneumonia) and for all age groups. The failure rate (5.6% of the children required NIV, and 4.5% required intubation) was low, similar to that reported in previous studies.6–8 Although HFNC is an increasingly popular method to provide respiratory therapy with a clinical intuition of efficacy, the level of evidence in children has been slow to evolve.

The example of bronchiolitis is interesting. In the study reported by Coletti et al,5 almost one quarter of the population (23.7%) had bronchiolitis, which is consistent with other reports.6,9 However, recent randomized control studies failed to support the use of HFNC in children with bronchiolitis. The recent TRAMONTANE study7 concluded that the failure rate was lower in nasal CPAP compared with HFNC for initial respiratory support in severe viral bronchiolitis. Kepreotes et al8 concluded that the early use of HFNC did not reduce time receiving oxygen compared with standard oxygen in moderately severe bronchiolitis.

So why is there so much enthusiasm for the use of HFNC in children? Probably because of its good tolerance and simplicity of use. As compared with NIV, HFNC is simpler to set up (no synchronization, single interface, only 2 settings [gas flow and FIO2]) and can be used in various clinical environments (eg, emergency department, inter-hospital transport, or ICU).1,6,10,11

HFNC is also well tolerated, as suggested by Coletti et al,5 who reported that only 2 subjects (0.3%) required discontinuation due to discomfort. Additionally, the main reasons for failure differed between the 2 groups in the in the TRAMONTANE study.7 In the HFNC group, failure was due to worsening of respiratory distress, whereas in the CPAP group, it was discomfort. Another reason that may explain why HFNC is attractive for use in pediatrics is the variable high flows that can be used.2 In adults, the maximum flow is 60 L/min (about 1 L/kg/min), whereas in small children, the device allows flows that are 2 or 3 times greater.1 The flow used in the most recent pediatric studies is heterogeneous, ranging from 0.7 L/kg/min for subjects with asthma to as high as 3 L/kg/min in the study reported by Coletti et al5 The higher the flow, the higher is the level of support.12 Hence, this single system seems to be able to provide various levels of support, determined by the flow, from oxygen supplementation to a CPAP effect. However, this range of flows leads to the question of what comparator to choose in controlled trials according to the HFNC flow used: standard oxygen, CPAP, or NIV?

The situation is probably best summarized in the study in preterm infants reported by Manley et al,13 who conclude that the equivalence of HFNC with nasal CPAP is based on a margin of non-inferiority of 20%. The controversial rationale was that many clinicians strongly prefer to use HFNC, and its use is widespread because of the perceived benefits over nasal CPAP. With greater comfort, simplicity, and probably effectiveness, HFNC has succeeded in finding a place in the hearts of pediatric intensivists and respiratory therapists. HFNC now requires a more convincing level of evidence from randomized control trials in the pediatric ICU.

Acknowledgments

We thank Philip Robinson for review of the manuscript.

Footnotes

  • Correspondence: Florent Baudin MD MSc, Réanimation Pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69500 Bron, France. E-mail: florent.baudin{at}chu-lyon.fr.
  • The authors have disclosed no conflicts of interest.

  • See the Original Study on Page 1023

  • Copyright © 2017 by Daedalus Enterprises

References

  1. 1.↵
    1. Ward JJ
    . High-flow oxygen administration by nasal cannula for adult and perinatal patients. Respir Care 2013;58(1):98–122.
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    1. Milési C,
    2. Boubal M,
    3. Jacquot A,
    4. Baleine J,
    5. Durand S,
    6. Odena MP,
    7. Cambonie G
    . High-flow nasal cannula: recommendations for daily practice in pediatrics. Ann Intensive Care 2014;4:29.
    OpenUrlCrossRefPubMed
  3. 3.↵
    1. Frat JP,
    2. Thille AW,
    3. Mercat A,
    4. Girault C,
    5. Ragot S,
    6. Perbet S,
    7. et al
    . High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med 2015;372(23):2185–2196.
    OpenUrlCrossRefPubMed
  4. 4.↵
    1. Nedel WL,
    2. Deutschendorf C,
    3. Moraes Rodrigues Filho E
    . High-flow nasal cannula in critically ill subjects with or at risk for respiratory failure: a systematic review and meta-analysis. Respir Care 2017;62(1):123–132.
    OpenUrlAbstract/FREE Full Text
  5. 5.↵
    1. Coletti KD,
    2. Bagdure DN,
    3. Walker LK,
    4. Remy KE,
    5. Custer JW
    . High flow nasal cannula utilization in pediatric critical care: an observational study. Respir Care 2017;62(8):1023–1029.
    OpenUrlAbstract/FREE Full Text
  6. 6.↵
    1. Baudin F,
    2. Gagnon S,
    3. Crulli B,
    4. Proulx F,
    5. Jouvet P,
    6. Emeriaud G
    . Modalities and complications associated with the use of high-flow nasal cannula: experience in a pediatric ICU. Respir Care 2016;61(10):1305–1310.
    OpenUrlAbstract/FREE Full Text
  7. 7.↵
    1. Milési C,
    2. Essouri S,
    3. Pouyau R,
    4. Liet JM,
    5. Afanetti M,
    6. Portefaix A,
    7. et al
    . High flow nasal cannula (HFNC) versus nasal continuous positive airway pressure (nCPAP) for the initial respiratory management of acute viral bronchiolitis in young infants: a multicenter randomized controlled trial (TRAMONTANE study). Intensive Care Med 2017;43(2):209–216.
    OpenUrlCrossRef
  8. 8.↵
    1. Kepreotes E,
    2. Whitehead B,
    3. Attia J,
    4. Oldmeadow C,
    5. Collison A,
    6. Searles A,
    7. et al
    . High-flow warm humidified oxygen versus standard low-flow nasal cannula oxygen for moderate bronchiolitis (HFWHO RCT): an open, phase 4, randomised controlled trial. Lancet 2017;389(10072):930–939.
    OpenUrlCrossRef
  9. 9.↵
    1. Wraight TI,
    2. Ganu SS
    . High-flow nasal cannula use in a paediatric intensive care unit over 3 years. Crit Care Resusc 2015;17(3):197–201.
    OpenUrl
  10. 10.↵
    1. Schlapbach LJ,
    2. Schaefer J,
    3. Brady AM,
    4. Mayfield S,
    5. Schibler A
    . High-flow nasal cannula (HFNC) support in interhospital transport of critically ill children. Intensive Care Med 2014;40(4):592–599.
    OpenUrlCrossRefPubMed
  11. 11.↵
    1. Kelly GS,
    2. Simon HK,
    3. Sturm JJ
    . High-flow nasal cannula use in children with respiratory distress in the emergency department: predicting the need for subsequent intubation. Pediatr Emerg Care 2013;29(8):888–892.
    OpenUrlCrossRefPubMed
  12. 12.↵
    1. Luo JC,
    2. Lu MS,
    3. Zhao ZH,
    4. Jiang W,
    5. Xu B,
    6. Weng L,
    7. et al
    . Positive end-expiratory pressure effect of 3 high-flow nasal cannula devices. Respir Care 2017 [Epub ahead of print]. doi: 10.4187/respcare.05337.
  13. 13.↵
    1. Manley BJ,
    2. Owen LS,
    3. Doyle LW,
    4. Andersen CC,
    5. Cartwright DW,
    6. Pritchard MA,
    7. et al
    . High-flow nasal cannulae in very preterm infants after extubation. N Engl J Med 2013;369(15):1425–1433.
    OpenUrlCrossRefPubMed
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Respiratory Care: 62 (8)
Respiratory Care
Vol. 62, Issue 8
1 Aug 2017
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High-Flow Nasal Cannula in the Pediatric ICU: Popular or Efficient?
Florent Baudin, Robin Pouyau
Respiratory Care Aug 2017, 62 (8) 1116-1117; DOI: 10.4187/respcare.05720

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High-Flow Nasal Cannula in the Pediatric ICU: Popular or Efficient?
Florent Baudin, Robin Pouyau
Respiratory Care Aug 2017, 62 (8) 1116-1117; DOI: 10.4187/respcare.05720
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