Infant Nasal High Flow: Clinical Paper Summaries Fisher &Paykel

Table of Contents KEY REFERENCES THERAPY OVERVIEW Research in high flow therapy (Dysart) ……………………………………………………………………………. S1 High flow nasal cannulae for respiratory support of preterm infants: a review of the evidence (Manley) ….. S2 CLINICAL OUTCOMES Comparison of Nasal High Flow with nasal continuous positive airway pressure (Collins) ………………….. S3 Intubation rates of infant with bronchiolitis (Schibler) ……………………………………………………………. S4 Nasal High Flow in infants with bronchiolitis (McKiernan) ………………………………………………………. S5 Retrospective study of Nasal High Flow versus CPAP (Shoemaker) ………………………………………….....

Infant Key References THERAPY OVERVIEW 1. Dysart K, Miller TL, Wolfson MR, Shaffer TH. Research in high flow therapy: mechanisms of action. Respiratory Medicine. 2009; 103: 1400-1405. Manley BJ, Dold SK, Davis PG, Roehr CC. High-flow nasal cannulae for respiratory support of preterm infants: a review of the evidence. Neonatology. 2012; 102: 300-308. Collins CL, Holberton JR, Barfield C, Davis PG. A randomised control trial to compare heated humidified high flow nasal cannulae with nasal continuous positive airway pressure post-extubation. Journal of Pediatrics. 2012. Schibler A, Pham TMT, Dunster...

S1. K Dysart, TL Miller, MR Wolfson, TH Shaffer Respiratory Medicine 2009; 103: 1400-1405 Research in high flow therapy: mechanisms of action AIM: To review proposed mechanisms for the efficacy of nasal high flow (NHF) therapy. DETAILS: NHF oxygen therapy is being increasingly utilized in a variety of patients with different diseases. The precise mechanisms by which NHF oxygen therapy alters gas exchange and influences the respiratory system have not been fully elucidated. However, available data suggest that there are five contributors to the effectiveness of NHF oxygen therapy. Washout of nasopharyngeal...

DEFINITIONS: Coanda effect A term originating from the field of aeronautical engineering. The Coanda effect is an entrainment effect whereby high-speed fluid from a nozzle entrains fluid from the body that it enters. An obstruction to this action by a wall/barrier causes a low-pressure area on one side of the jet, causing a deflection in flow, redirecting flow to the barrier Continuous positive airway pressure (CPAP) A technique of respiratory therapy in which airway pressure is maintained above atmospheric pressure throughout the respiratory cycle by pressurization of the ventilatory circuit...

S2. BJ Manley, SK Dold, PG Davis, CC Roehr Neonatology 2012; 102: 300-308 High-flow nasal cannulae for respiratory support of preterm infants: a review of the evidence AIM: To review evidence for the use of high-flow nasal cannula (HFNC) oxygen therapy in preterm infants based on data drawn from 19 studies identified by literature searching. DETAILS: HFNC delivers humidified gas via nasal prongs, which are available in a variety of sizes. The use of HFNC oxygen therapy in preterm infants is increasing in popularity. Indications where HFNC is being used include: primary support for respiratory...

CONCLUSION: Further research is needed to clearly define whether HFNC oxygen therapy is effective and safe compared with nCPAP. NCPAP is the current standard of care for noninvasive respiratory support. The results of ongoing studies investigating the use of HFNC as post-extubation support and for the treatment of RDS are required before any recommendation can be made about the widespread use of HFNC to treat preterm infants. Evidence for the feasibility of HFNC oxygen therapy as an alternative respiratory support treatment for preterm infants is growing. Heated, humidified HFNC systems with...

DEFINITIONS: Apnoea of prematurity (AOP) High-flow therapy A phenomenon that occurs in premature babies when the part of the central nervous system that controls breathing is not yet mature enough to allow continuous breathing. This results in large bursts of breath followed by periods of shallow or stopped breathing. (HFNC) A device designed to provide a high flow of heated, humidified oxygen and air to patients requiring respiratory support, delivered through nasal cannulae. Nasal continuous positive airway pressure (nCPAP) A technique of respiratory therapy in which airway pressure is maintained...

S3. CL Collins, JR Holberton, C Barfield, PG Davis Journal of Pediatrics 2013 Dec 19 [epub ahead of print] A randomized controlled trial to compare heated humidified high-flow nasal cannulae with nasal continuous positive airway pressure postextubation in premature infants AIM: To determine whether heated humidified (HH) high-flow nasal cannula (HFNC) oxygen therapy increases the rate of successful extubation in premature infants following endotracheal positive pressure ventilation, compared with conventional nasal continuous airway pressure (nCPAP) oxygen therapy. METHOD: In this prospective...

DISCUSSION: HFNC and NCPAP oxygen therapy were associated with similar rates of extubation failure at 7 days in this study. The extubation failure rate with nCPAP oxygen therapy in this study was lower than expected based on historical controls at the same institution (34% vs. 50% in 2004−2006), this difference may be due to the change in the standard nCPAP delivery device used from a single nasopharyngeal prong to binasal prongs in late 2005. Nasal trauma was significantly reduced with HFNC versus nCPAP oxygen therapy. Although damage to the nasal mucosa caused by the binasal prongs used in...