Initiating HFNC is relatively simple, but close monitoring is essential. Its mode of action is original and complex. The cannula was first employed in intensive care units (ICUs), then in emergency departments, and today is finding use during pre- or inter-hospital transport.Ĭlinicians are quite rightly raising questions about where it should be positioned among the systems of noninvasive respiratory support, such as high-concentration face masks and nasal CPAP. Its use in pediatrics departments is more recent and generally is restricted to children with moderate bronchiolitis. Over the last decade, high-flow nasal cannula (HFNC) has increasingly been used for oxygen delivery in neonatology departments, gradually replacing nasal continuous positive airway pressure (CPAP). As for any form of respiratory support, HFNC initiation in patients requires close monitoring, whether it be for pre- or inter-hospital transport or in the emergency department or the pediatric intensive care unit. But, the experience with this device in neonatology and adult intensive care may broaden the pediatric indications to include weaning from invasive ventilation and acute asthma. Currently, most of the studies in the pediatric literature suggest the benefits of HFNC therapy only for moderately severe acute viral bronchiolitis. HFNC may also create positive pharyngeal pressure to reduce the work of breathing, which positions the device midway between classical oxygen delivery systems, like the high-concentration face mask and continuous positive airway pressure (CPAP) generators. The use of nasal cannula adapted to the infant’s nares size to deliver heated and humidified gas at high flow rates has been associated with improvements in washout of nasopharyngeal dead space, lung mucociliary clearance, and oxygen delivery compared with other oxygen delivery systems. In pediatrics, HFNC use continues to increase as the system is easily set up and is well tolerated by patients. High-flow nasal cannula (HFNC) is a relatively new device for respiratory support.
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