High-Flow Nasal Cannula Reduces Effort of Breathing But Not Consistently via Positive End-Expiratory Pressure

Guglielmo, R.D.; Hotz, Justin; Ross, Patrick; Deakers, Timothy; Diep, Jennifer; Newth, Christopher J. L.; Khemani, Robinder G.

doi:10.1016/j.chest.2022.03.008

Cited by 12 publications

(25 citation statements)

References 43 publications

(52 reference statements)

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“…Interestingly, not all patients behaved similarly, with some showing a decrease in lung volume with higher flow rates (Figure 3). These findings are in line with a very recent study concurrent with ours and with similar methods performed by another group 14 . They concluded that this behavior was evidence against the role of positive airway pressure as the main mechanism of action of HFNC.…”

Section: Discussionsupporting

confidence: 93%

“…Previous studies have used EIT to evaluate the effect of HFNC, 25–28 two in the pediatric population 13,14 . Hough et al 13 included 13 infants with bronchiolitis and evaluated the EELZ under flow rates of 2 and 8 L/min, which correspond to flow rates of approximately 0.4 (off HFNC) and 1.7 L·kg −1 ·min −1 (on HFNC).…”

Section: Discussionmentioning

confidence: 99%

“…One of them assessed two flow rates: 2 (considered low flow) and 8 L/min (considered high flow) 13 . The most recent, which was concomitant with ours, assessed four different flow rates: 0.5, 1.0, 1.5, and 2.0 L·kg −1 ·min −1 14 …”

Section: Introductionmentioning

confidence: 86%

“…13 The most recent, which was concomitant with ours, assessed four different flow rates: 0.5, 1.0, 1.5, and 2.0 L•kg −1 •min −1 . 14 Our study evaluated the effects of four different flow rates, 2.0, 1.5, 1.0, and 0.5 L•kg −1 •min −1 , on the variations of the pulmonary volume using EIT in infants with acute viral bronchiolitis and treated with HFNC.…”

mentioning

confidence: 99%

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Effect of flow rate on the end‐expiratory lung volume in infants with bronchiolitis using high‐flow nasal cannula evaluated through electrical impedance tomography

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Costa

et al. 2022

Pediatric Pulmonology

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 86%

mentioning

confidence: 99%

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Effect of flow rate on the end‐expiratory lung volume in infants with bronchiolitis using high‐flow nasal cannula evaluated through electrical impedance tomography

Nascimento

Prado

Costa

et al. 2022

Pediatric Pulmonology

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“…This concept has been challenged by a recent study from Guglielmo and co-workers. In their trial, HFNC applied to 22 children with bronchiolitis reduced breathing effort, without a consistent increase in end-expiratory lung volume and no significant change in tidal volume or transpulmonary pressure, raising the hypothesis that PEEP application is not the primary HFNC mechanism for reducing WOB in bronchiolitis (38).…”

Section: Generation Of Positive End-expiratory Pressure Work Of Breat...mentioning

confidence: 96%

High-Flow Nasal Cannula Oxygen Therapy: Physiological Mechanisms and Clinical Applications in Children

et al. 2022

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High-flow nasal cannula (HFNC) oxygen therapy has rapidly become a popular modality of respiratory support in pediatric care. This is undoubtedly due to its ease of use and safety, which allows it to be used in a wide variety of settings, ranging from pediatric intensive care to patients' homes. HFNC devices make it possible to regulate gas flow and temperature, as well as allowing some nebulized drugs to be administered, features very useful in children, in which the balance between therapeutic effectiveness and adherence to treatment is pivotal. Although the physiological effects of HFNC are still under investigation, their mechanisms of action include delivery of fixed concentration of oxygen, generation of positive end-expiratory pressure, reduction of the work of breathing and clearance of the nasopharyngeal dead space, while providing optimal gas conditioning. Nevertheless, current evidence supports the use of HFNC mainly in moderate-to-severe bronchiolitis, whereas for asthma exacerbations and breath sleeping disorders there is a lack of randomized controlled trials comparing HFNC to continuous positive airway pressure (CPAP) and non-invasive ventilation (NIV), which are essentials for the identification of response and non-response predictors. In this regard, the development of clinical guidelines for HFNC, including flow settings, indications, and contraindications is urgently needed.

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Toward Elucidating the Mechanism of Action of High-Flow Nasal Cannula Support in Children

Rotta

Rehder

2022

Chest

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High-Flow Nasal Cannula Reduces Effort of Breathing But Not Consistently via Positive End-Expiratory Pressure

Cited by 12 publications

References 43 publications

Effect of flow rate on the end‐expiratory lung volume in infants with bronchiolitis using high‐flow nasal cannula evaluated through electrical impedance tomography

Effect of flow rate on the end‐expiratory lung volume in infants with bronchiolitis using high‐flow nasal cannula evaluated through electrical impedance tomography

High-Flow Nasal Cannula Oxygen Therapy: Physiological Mechanisms and Clinical Applications in Children

Toward Elucidating the Mechanism of Action of High-Flow Nasal Cannula Support in Children

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