Tension pneumocephalus induced by high-flow nasal cannula ventilation in a neonate

Iglesias-Deus, Alicia; Pérez-Muñuzuri, Alejandro; López-Suárez, Olalla; Crespo, Pilar M.; Couce, María L.

doi:10.1136/archdischild-2015-309777

Cited by 16 publications

(17 citation statements)

References 6 publications

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“…In infants weighing <1000 g, we found that flows as low as 4–6 L/min generate average pEEP similar to nCPAP 6 cm H 2 O and flows of 7–8 L/min delivered pEEP higher than nCPAP 6 cm H 2 O. Although rare, HFNC-related complications have been reported 23 24. Awareness of pressures delivered to vulnerable infants is important and may aid clinicians in prescribing flow rates.…”

Section: Discussionmentioning

confidence: 81%

Physiological effects of high-flow nasal cannula therapy in preterm infants

Liew

Fenton

Harigopal

et al. 2019

Arch Dis Child Fetal Neonatal Ed

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ObjectiveHigh-flow nasal cannula (HFNC) therapy is increasingly used in preterm infants despite a paucity of physiological studies. We aimed to investigate the effects of HFNC on respiratory physiology.Study designA prospective randomised crossover study was performed enrolling clinically stable preterm infants receiving either HFNC or nasal continuous positive airway pressure (nCPAP). Infants in three current weight groups were studied: <1000 g, 1000–1500 g and >1500 g. Infants were randomised to either first receive HFNC flows 8–2 L/min and then nCPAP 6 cm H2O or nCPAP first and then HFNC flows 8–2 L/min. Nasopharyngeal end-expiratory airway pressure (pEEP), tidal volume, dead space washout by nasopharyngeal end-expiratory CO2 (pEECO2), oxygen saturation and vital signs were measured.ResultsA total of 44 preterm infants, birth weights 500–1900 g, were studied. Increasing flows from 2 to 8 L/min significantly increased pEEP (mean 2.3–6.1 cm H2O) and reduced pEECO2 (mean 2.3%–0.9%). Tidal volume and transcutaneous CO2 were unchanged. Significant differences were seen between pEEP generated in open and closed mouth states across all HFNC flows (difference 0.6–2.3 cm H2O). Infants weighing <1000 g received higher pEEP at the same HFNC flow than infants weighing >1000 g. Variability of pEEP generated at HFNC flows of 6–8 L/min was greater than nCPAP (2.4–13.5 vs 3.5–9.9 cm H2O).ConclusionsHFNC therapy produces clinically significant pEEP with large variability at higher flow rates. Highest pressures were observed in infants weighing <1000 g. Flow, weight and mouth position are all important determinants of pressures generated. Reductions in pEECO2 support HFNC’s role in dead space washout.

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Section: Discussionmentioning

confidence: 81%

Physiological effects of high-flow nasal cannula therapy in preterm infants

Liew

Fenton

Harigopal

et al. 2019

Arch Dis Child Fetal Neonatal Ed

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“…The panel judged the anticipated undesirable effects of HFNC compared to COT and NIPPV to be minimal. Adverse events directly related to HFNC are uncommon and have been mostly reported in children and infants [22][23][24][25][26]. The use of HFNC may delay intubation, however the due to the heterogeneity of study designs and risk of confounding we were not able to pool data evaluating this outcome.…”

Section: Rationalementioning

confidence: 99%

The role for high flow nasal cannula as a respiratory support strategy in adults: a clinical practice guideline

et al. 2020

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Purpose High flow nasal cannula (HFNC) is a relatively recent respiratory support technique which delivers high flow, heated and humidified controlled concentration of oxygen via the nasal route. Recently, its use has increased for a variety of clinical indications. To guide clinical practice, we developed evidence-based recommendations regarding use of HFNC in various clinical settings. Methods We formed a guideline panel composed of clinicians, methodologists and experts in respiratory medicine. Using GRADE, the panel developed recommendations for four actionable questions. Results The guideline panel made a strong recommendation for HFNC in hypoxemic respiratory failure compared to conventional oxygen therapy (COT) (moderate certainty), a conditional recommendation for HFNC following extubation (moderate certainty), no recommendation regarding HFNC in the peri-intubation period (moderate certainty), and a conditional recommendation for postoperative HFNC in high risk and/or obese patients following cardiac or thoracic surgery (moderate certainty). Conclusions This clinical practice guideline synthesizes current best-evidence into four recommendations for HFNC use in patients with hypoxemic respiratory failure, following extubation, in the peri-intubation period, and postoperatively for bedside clinicians. Electronic supplementary material The online version of this article (10.1007/s00134-020-06312-y) contains supplementary material, which is available to authorized users.

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“…Recent guidelines urge caution with simultaneous use of high‐flow nasal oxygen and facemask ventilation . Cases of pneumocephalus , pneumo‐orbitus , epistaxis, subcutaneous emphysema, pneumomediastinum, pneumothorax , oesophagealrupture and gastric rupture have all been reported with use of nasal cannulae, largely in paediatrics.…”

Section: Complications Of Apnoeic Oxygenationmentioning

confidence: 99%

Uses and mechanisms of apnoeic oxygenation: a narrative review

Lyons

Callaghan

2019

Anaesthesia

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Apnoeic oxygenation refers to oxygenation in the absence of spontaneous respiration or mechanical ventilation. It has been described in humans for over half a century and has seen a resurgence in interest given its potential to delay oxygen desaturation during airway management, especially with the advent of high-flow nasal cannulae. This narrative review summarises our current understanding of the mechanisms of gas exchange during apnoeic oxygenation and its diverse range of clinical applications, including its use at induction of anaesthesia and for the facilitation of 'tubeless anaesthesia'. Additional discussion covers use in critical care, obese, obstetric and paediatric sub-populations. The article also highlights current research efforts aiming to enhance the evidence base for the use of this technique.

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Tension pneumocephalus induced by high-flow nasal cannula ventilation in a neonate

Cited by 16 publications

References 6 publications

Physiological effects of high-flow nasal cannula therapy in preterm infants

Physiological effects of high-flow nasal cannula therapy in preterm infants

The role for high flow nasal cannula as a respiratory support strategy in adults: a clinical practice guideline

Uses and mechanisms of apnoeic oxygenation: a narrative review

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