Heated, Humidified High-Flow Nasal Cannula Therapy: Yet Another Way to Deliver Continuous Positive Airway Pressure?

Abstract

Oral cavity pressure can estimate the level of continuous positive airway pressure. Continuous positive airway pressure generated with heated, humidified, high-flow nasal cannula treatment depends on the flow rate and weight. Only in the smallest infants with the highest flow rates, with the mouth fully closed, can clinically significant but unpredictable levels of continuous positive airway pressure be achieved. We conclude that heated, humidified high-flow nasal cannula should not be used as a replacement for delivering continuous positive airway pressure.

Comparison of HFNC, bubble CPAP and SiPAP on aerosol delivery in neonates: An in‐vitro study

“…Both Kubicka et al (2008) and Wilkinson et al (2008) verify that there is a linear relationship between the infant's weight and the flow rate with the pressure generated. However, they have contradictory results regarding mouth closure.…”

“…A linear relationship was observed between airflow and IPP generated at ≥ 3 LPM, so the researchers recommended further investigation via a larger study of the variable airway pressure generated by HFNC and its outcome on patient safety. Kubicka, Limauro, and Darnall (2008) also conducted a study to measure the approximate CPAP level produced by heated humidified high flow nasal cannula (HHHFNC) in infants. Their study included 27 infants whose gestational age was 29.1-44.7 weeks and whose weight was 835-3735 g that were treated with HHHFNC (both Vapotherm 2000i and F&P devices) and excluded infants who had neuromuscular disorders, multiple congenital and/or chromosomal abnormalities, and severe neurologic impairment including a grade 3 or 4 intraventricular hemorrhage.…”

Therapeutic interventions and short-term outcomes for infants with severe bronchopulmonary dysplasia born at <32 weeks’ gestation

“…Second, receipt of high-flow nasal cannula support was included in the case definition of sBPD given the observed correlation between high-flow rates and delivered positive airway pressure. 17,18 The main outcomes before discharge included mortality, selected medication use including corticosteroids and the provisions of respiratory care were reported for all eligible infants. In addition to mortality, length of stay in the CHND NICU was reported and stratified by mortality before discharge.…”

Apnea of prematurity: pathogenesis and management strategies

“…The magnitude of this distending pressure depends on factors such as the flow rate, nasal leak and mouth closure. 95 We do not often monitor the airway pressure while using high flow. Benefits comparable to CPAP have been reported with this form of therapy.…”