High-Flow Nasal Cannula in Pediatric Patients: A Survey of Clinical Practice

Miller, Andrew G; Gentle, Michael A; Tyler, Lisa; Napolitano, Natalie

doi:10.4187/respcare.05961

Cited by 52 publications

(51 citation statements)

References 23 publications

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“…In‐line placement of a nebulizer with HFNC has been described to solve the difficulty and has attracted attention from clinicians in recent years . The survey among American pediatric respiratory therapists showed that 75% of respondents delivered aerosol therapy during HFNC . Pediatric patients were reported to be more comfortable and less anxious after inhaling aerosol bronchodilator via HFNC, which has also shown the potential benefits of avoiding intubation in a group of pediatric asthma patients, 26% of whom already had acidosis at PICU admission …”

Section: Introductionmentioning

confidence: 99%

“…8,9,[11][12][13] The survey among American pediatric respiratory therapists showed that 75% of respondents delivered aerosol therapy during HFNC. 14 Pediatric patients were reported to be more comfortable and less anxious after inhaling aerosol bronchodilator via HFNC, 8,9 which has also shown the potential benefits of avoiding intubation in a group of pediatric asthma patients, 26% of whom already had acidosis at PICU admission. 11 Aerosol delivery via HFNC for pediatric patients has been characterized by means of in vitro 10,[15][16][17][18] and radiolabeled in vivo studies.…”

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confidence: 99%

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Decrease the flow setting to improve trans‐nasal pulmonary aerosol delivery via “high‐flow nasal cannula” to infants and toddlers

Gong²,

Ari

et al. 2019

Pediatric Pulmonology

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Objectives Trans‐nasal pulmonary aerosol delivery for infants and toddlers has recently gained popularity, however, the reported lung deposition is low. We aimed to investigate the influential factors to improve the delivery. Methods Anatomic airway manikins simulating infant (5 kg) and toddler (15 kg) with collecting filter connected the trachea and breath simulator, were set to represent quiet and distressed breathing. Nasal cannula flow was set at 0.125, 0.25, 0.5, 1, and 2 L/kg/min. A mesh nebulizer (Aerogen) was placed at the inlet of humidifier (Fisher & Paykel) and proximal to patient. Albuterol (5 mg in 1 mL) was nebulized for each condition (n = 3). Drug was eluted from the filter and assayed with UV spectrophotometry (276 nm). Results Inhaled dose was higher with nebulizer placed at the inlet of humidifier than proximal to patient in all settings, except the infant model at low gas flow settings (0.125 and 0.25 L/kg/min). When nebulizer was placed at the inlet of humidifier, inhaled dose was higher when gas flow was below patient's inspiratory flow than when gas flow exceeded patient's inspiratory flow (8.77 ± 3.84 vs 2.16 ± 1.29%, P < 0.001); aerosol deposition increased as gas flow decreased, with greatest deposition at gas flow of 0.25 L/kg/min (11.29 ± 2.15%). A multiple linear regression identified gas flow as the primary predictor of aerosol delivery. Conclusions Trans‐nasal pulmonary aerosol delivery was significantly improved when gas flow was below patient's inspiratory flow, aerosol deposition increased with decreased nasal cannula flow, with greatest deposition at 0.25 L/kg/min.

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Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

Decrease the flow setting to improve trans‐nasal pulmonary aerosol delivery via “high‐flow nasal cannula” to infants and toddlers

Gong²,

Ari

et al. 2019

Pediatric Pulmonology

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“…10 The observation that toddlers better tolerate nasal oxygen administration than mask has led to the in-line placement of nebulizers with high-flow nasal cannula (HFNC) devices for transnasal pulmonary delivery. [11][12][13][14] This approach combines benefits of patient's acceptance to receive aerosolized medication for extended dosing periods with the effects of heated humidified gas at the high-flow rate, which has been shown to reduce the patients' work of breathing and improve ventilation. 15,16 Vibrating mesh nebulizer (VMN) is preferred during aerosol delivery via HFNC due to no gas required to generate an aerosol, negligible residual volume, and quiet operation.…”

Section: Introductionmentioning

confidence: 99%

In vitro comparison of unit dose vs infusion pump administration of albuterol via high‐flow nasal cannula in toddlers

Fink

2019

Pediatric Pulmonology

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Objectives Transnasal pulmonary aerosol delivery using high‐flow nasal cannula (HFNC) devices has become a popular route of aerosol administration in toddlers. Clinically, albuterol is administered using an infusion pump or unit doses. However, little evidence is available to compare the two administration strategies. Methods A toddler manikin (15 kg) with appropriate anatomic airway was connected with collecting filter to a simulator of distressed breathing. HFNC device with mesh nebulizer placed at the inlet of a humidifier at 37°C, with the gas flow set at 25 and 3.75 L/min. Five milligrams of albuterol was delivered in all experiments. With infusion pump administration, albuterol concentrations of 5 and 1 mg/mL were delivered at 4 and 20 mL/hr for 15 minutes. With unit dose administration, 1 mL (5 mg/mL) and 2 mL (2.5 mg/mL) of albuterol were nebulized. Additional tests with mouth open and nebulizers via mask were using 5 mg/1 mL for mesh nebulizer and 5 mg/3 mL for jet nebulizer (n = 3). The drug was eluted from the filter and assayed with UV spectrophotometry (276 nm). Results The inhaled dose was higher with unit dose than infusion pump administration with gas flows of 25 L/min (2.66 ± 0.38 vs 1.16 ± 0.28%; P = .004) and 3.75 L/min (10.51 ± 1.29 vs 8.58 ± 0.68%; P = .025). During unit dose administration, compared with closed‐mouth breathing, open‐mouth breathing generated a higher inhaled dose at 3.75 L/min and lower inhaled dose at 25 L/min. Compared to the nebulizers via mask with both open and closed‐mouth breathing, nebulization via HFNC at 3.75 L/min generated greater inhaled dose, while HFNC at 25 L/min generated lower inhaled dose. Conclusions During transnasal aerosol delivery, the inhaled dose was higher with medication administrated using unit dose than using an infusion pump.

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“…A survey among American Pediatric respiratory therapists showed that out of 75% of respondents who administered aerosol therapy during HFNC, 77% delivered aerosol via VMN and 23% removed the patient from HFNC for the aerosol delivery. Thirteen percent of them decreased HFNC flow to improve aerosol delivery …”

mentioning

confidence: 99%

“…Thirteen percent of them decreased HFNC flow to improve aerosol delivery. 6 Aerosol administration via high-flow nasal cannula is a new and innovative approach in pediatric pulmonology; yet, there is lack of consistent data regarding the particle deposition in the lungs particularly when using high-flow rates, often close to 2 to 3 L/kg/min for critically ill children. The heated humidification can further affect the particle size and cause gravimetric sedimentation 7 thereby decreasing pulmonary delivery.…”

mentioning

confidence: 99%

Is aerosol delivery by high‐flow nasal cannula in children an effective alternative to face mask aerosol nebulization?

Kesavan

Amirav²

2019

Pediatric Pulmonology

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High-Flow Nasal Cannula in Pediatric Patients: A Survey of Clinical Practice

Cited by 52 publications

References 23 publications

Decrease the flow setting to improve trans‐nasal pulmonary aerosol delivery via “high‐flow nasal cannula” to infants and toddlers

Decrease the flow setting to improve trans‐nasal pulmonary aerosol delivery via “high‐flow nasal cannula” to infants and toddlers

In vitro comparison of unit dose vs infusion pump administration of albuterol via high‐flow nasal cannula in toddlers

Is aerosol delivery by high‐flow nasal cannula in children an effective alternative to face mask aerosol nebulization?

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