High-flow Nasal Cannula in Pediatric Patients

Abstract

High-flow nasal cannula (HFNC) provides conditioned high-flow oxygen through an open system with high pressure and high velocity. HFNC has been widely used in neonatal patients with comparable benefit to CPAP; however, the use in pediatric patients has not been well evaluated. In pediatric patients, a regular nasal cannula is widely used as oxygen therapy, but the flow provided is limited because the humidity is not optimal. While HFNC as noninvasive oxygen therapy can deliver heated, humidified gas, via nasal cannula. High-velocity HFNC makes oxygen-rich gases occupy the dead space of the nasopharynx, increasing FiO2, and improving alveolar ventilation. The use of HFNC in children begins with bronchiolitis patients, also considered effective in various respiratory disorders including cases of hypoxemic respiratory failure. HFNC has been shown to have a better patient tolerance, less nose damage, and less work for the staff than CPAP and noninvasive ventilators (NIV). HFNC can be used in the emergency department and even the patient ward, while CPAP and NIV require intensive care unit facility as it needs close monitoring. HFNC is considered safe with mild side effects such as epistaxis and skin irritation that have been reported. While serious side effects such as pneumothorax are rarely reported because open system HFNC can prevent a sudden increase in airway pressure.