Reduced intubation rates for infants after introduction of high-flow nasal prong oxygen delivery

Abstract

HFNP therapy has dramatically changed ventilatory practice in infants <24 months of age in our institution, and appears to reduce the need for intubation in infants with viral bronchiolitis.

Glass half empty or half full? The story of high-flow nasal cannula therapy in critically ill children

“…In (Fig. 1) physiological studies demonstrate that HFNC is associated with improvement in respiratory rate, heart rate, end-tidal carbon dioxide and measured work of breathing within hours of initiation, and observational studies have shown that HFNC may reduce the need for intubation and invasive ventilation [6,7]. HFNC is also associated with high levels of patient comfort, and has the advantage of being easy to use with relatively little staff training, including outside the intensive care unit and during inter-hospital transport [8,9].…”

“…First, the primary outcome is a composite endpoint comprising criteria for lack of clinical improvement as well as intolerance to the applied intervention, making it difficult to reproduce in other studies and to compare with other trials. It is also arguable whether the primary outcome is really a clinically important outcome; endotracheal intubation would certainly have been one, but the low rate of intubation in bronchiolitis in the current era (<5%) would have necessitated a much larger sample size [7,12]. The duration of non-invasive ventilation (HFNC, CPAP and/or BIPAP) was greater in HFNC patients (98.3 vs 72.9 h, p = 0.2), suggesting that length of ventilation may be a candidate outcome in future trials.…”

Oxygen therapy via high flow nasal cannula in pediatric intensive care unit

“…Furthermore, when humidified and heated oxygen-air mixture was Fraction of inspired oxygen administered to trachea, upper airway resistance was also reduced 10 . In a study published in 2011 where HFNC therapy was administered to infants, only 6 (3.6%) of 166 patients with bronchiolitis required invasive ventilation 11 .…”

High flow nasal cannulae for acute viral bronchiolitis in young infants: evidence-based medicine is underway to define target populations and optimal flows

“…New treatments often generate pendulum swings, from great resistance to great enthusiasm and back, until the appropriate target population is found. At the outset, cohort studies suggested a lower intubation rate in patients receiving HFNC treatment (2,3). A later study in an emergency department found that, among children with respiratory distress, those diagnosed with AVB showed better responses to treatment with HFNC (4).…”