High flow nasal cannula therapy in children: working principles and treatment failure predictors
1Pediatric Intensive Care Unit, Hippokration General Hospital, 54642 Thessaloniki, Greece
2Department of Anesthesia, Hippokration General Hospital, 54642 Thessaloniki, Greece
33rd Pediatric Department, Aristotle University of Thessaloniki, Hippokration General Hospital, 54642 Thessaloniki, Greece
Submitted: 11 February 2022 Accepted: 14 April 2022
Online publish date: 12 May 2022
High Flow Nasal Cannula (HFNC) delivers high flowrates of a heated air/oxygen fresh gas breathing mixture, in an open system, at the exact amount of fraction inspired oxygen, and at the optimum hydration level. By definition, due to high flow rates, higher than 2 L/min, it produces a wash out of the anatomic dead space and the End-tidal Carbon dioxide (EtCO2), and augments thus effective alveolar ventilation at the same rate of minute ventilation, helping reduce partial arterial pressure of Carbon dioxide (PaCO2) levels. Although depending on mouth closure and the relative size of the nasal cannula prongs related to nares, it produces a minimum Positive End Expiratory Pressure (PEEP) level, which is especially helpful in keeping unstable alveoli open, recruiting lung volume, and increasing the functional residual capacity. It reduces respiratory resistance and the high work of breathing which is a common feature in patients with respiratory failure. But its most important characteristics are the ease of implementation and good patient tolerance. It has emerged as a promising support mode in the last decade, and its use is being continuously expanded. Although it started from neonates, it expanded to children and adults, and tested in all causes of acute hypoxemic respiratory failure, especially in bronchiolitis, and in post-extubation respiratory failure as well, starting from Emergency Department (ED), Pediatric Ward (PW), Pediatric Intensive Care Unit (PICU), and during transportation. Comparisons and meta-analyses, although not of equal modalities, have shown that it is definitely better than Standard Oxygen Therapy (SOT), and rather inferior to Continuous Positive Airway Pressure (CPAP). The aim of the present study is to explore the HFNC position in the timeline of recommendations for mechanical ventilation in critically ill children. We present a review on HFNC literature evidence in patients aged 1 month to 18 years, focusing on its mechanism of action, clinical effects, and timely recognition of treatment failure predictors.
High flow nasal cannula-HFNC; Working principles; Treatment failure predictors; Pediatric intensive care unit-PICU; Infants; Children
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Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.
Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.
IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.
Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.
Scopus: CiteScore 0.5(2019) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.
Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.