The use of high-flow nasal cannula in the pediatric emergency department

Katherine N. Slain, Steven L. Shein, Alexandre T. Rotta

To summarize the current literature describing high-flow nasal cannula (HFNC) use in children, the components and mechanisms of action of a HFNC system, the appropriate clinical applications, and its role in the pediatric emergency department (ED). A computer-based search of PubMed/MEDLINE and Google Scholar for literature on HFNC use in children was performed. HFNC, a non-invasive respiratory support modality, provides heated and fully humidified gas mixtures to patients via a nasal cannula interface. HFNC likely supports respiration though reduced inspiratory resistance, washout of the nasopharyngeal dead space, reduced metabolic work related to gas conditioning, improved airway conductance and mucociliary clearance, and provision of low levels of positive airway pressure. Most data describing HFNC use in children focuses on those with bronchiolitis, although HFNC has been used in children with other respiratory disease. Introduction of HFNC into clinical practice, including in the ED, has been associated with decreased rates of endotracheal intubation. Limited prospective interventional data suggest that HFNC may be similarly efficacious as continuous positive airway pressure (CPAP) and more efficacious than standard oxygen therapy for some patients. Patient characteristics, such as improved tachycardia and tachypnea, have been associated with a lack of progression to endotracheal intubation. Reported adverse effects are rare. HFNC should be considered for pediatric ED patients with respiratory distress not requiring immediate endotracheal intubation; prospective, pediatric ED-specific trials are needed to better determine responsive patient populations, ideal HFNC settings, and comparative efficacy vs. other respiratory support modalities.