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Use Of High Flow Nasal Canula

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You might want to read this article published in the NEJM this year:




they used HFNC right after extubation and showed that it was equally effective as CPAP to keep infants from being reintubated.


From the methods section:




Infants in the nasal-cannulae group were treated with the Optiflow device, which included the MR850 humidifier and binasal infant cannulae (Fisher & Paykel Healthcare). Infants were fitted with prongs that maintained a leak at the nose, with the aim of occluding approximately half the nares. The device includes a pressure-relief valve that limits circuit pressure to 45 cm of water. The starting flow rate was based on the size of the prongs used, with 5 liters per minute for “premature” or “neonatal” prongs or 6 liters per minute for “infant,” “intermediate infant,” or “pediatric” prongs. Flow rates were altered at the physician's discretion in a stepwise fashion, with mandated limits between 2 liters per minute and the maximum recommended for the prong size: 6 liters per minute for “premature” and “neonatal” prongs, 7 liters per minute for “infant” or “intermediate infant” prongs, and 8 liters per minute for “pediatric” prongs. For infants who were weaned to 2 liters per minute and who had a fraction of inspired oxygen of less than 0.3 for more than 24 hours, treatment with the high-flow nasal cannulae could be stopped, although such cessation of therapy was not mandatory, and earlier cessation was ordered at the discretion of the treating team if the fraction of inspired oxygen was less than 0.3.
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Here is also a paper that was one of our Leading articles some time ago:

High-Flow Nasal Cannulae for Respiratory Support of Preterm Infants: A Review of the Evidence


Background: High-flow nasal cannulae (HFNC) are gaining in popularity as a form of non-invasive respiratory support for preterm infants in neonatal intensive care units around the world. They are proposed as an alternative to nasal continuous positive airway pressure (NCPAP) in a variety of clinical situations, including post-extubation support, primary therapy from birth and ‘weaning’ from NCPAP.

Objectives: To present and discuss the available evidence for the use of HFNC in the preterm population.

Methods: An internet-based literature search for relevant, original research articles (both randomised studies and not) on the use of HFNC in preterm infants was undertaken.

Results: A total of 19 studies were included in the review. Distending pressure generated by HFNC in preterm infants increases with increasing flow rate and decreasing infant size and varies according to the amount of leak around the prongs. HFNC may be as effective as NCPAP at improving respiratory parameters such as tidal volume and work of breathing in preterm infants, but probably only at flow rates >2 litres/min. The efficacy and safety of HFNC in preterm infants remain to be determined.

Conclusions: There is growing evidence of the feasibility of HFNC as an alternative to other forms of non-invasive ventilation in preterm infants. However, there remains uncertainty about the efficacy and safety of HFNC in this population. Until the results of larger randomised trials are known, widespread use of HFNC to treat preterm infants cannot be recommended.


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