Elsevier

Respiratory Medicine

Volume 131, October 2017, Pages 210-214
Respiratory Medicine

The use of high-flow nasal cannula (HFNC) as respiratory support in neonatal and pediatric intensive care units in Germany – A nationwide survey

https://doi.org/10.1016/j.rmed.2017.08.027Get rights and content
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Highlights

  • HFNC serves as respiratory support not only on NICUs, but also on PICUs in Germany.

  • Indications, particularly in older childhood are widening.

  • Severe pressure-depending side effects have been reported by the hospitals.

  • Applied flow rates vary strongly among the clinics.

Abstract

Background

High-flow nasal cannula (HFNC)1 is a technique of oxygen supply, initially being used as a potentially less-invasive alternative to nasal continuous positive airway pressure (nCPAP)2 for premature infants/neonates, which nowadays crosses the border of neonatal care. HFNC builds up a positive end-expiratory pressure (PEEP)3 but lacks the opportunity for continuous monitoring. Therefore, pressure-depending complications are a risk. Our goal was to evaluate the current use of HFNC in Germany regarding indications, techniques of application and complications experienced.

Studydesign

We used a questionnaire sent to 226 pediatric clinics.

Results

We received responses from 67 pediatric clinics (29.6%). HFNC was applied in the age group of 8 to 14 years in 42% and between 14 and 18 years in 33% of the clinics. 54% of the clinics have been using HFNC for more than 3 years. Applied flow rates varied strongly among the clinics. 70% of the clinics use HFNC outside of the established indications (alternative to nCPAP for premature infants and neonates, bronchiolitis) for pneumonia, support after extubation and non-adherence to nCPAP. Severe complications such as pneumothorax have been seen by 17,9% of the clinics.

Conclusion

We reported for the first time a nationwide overview about the expanded use of HFNC in pediatric clinics. Our results emphasize the fact that, even though HFNC is widely accepted as a non-invasive procedure there is still a potential of severe side effects. Therefore the use of HFNC should be monitored continuously and closely within an intensive or intermediate care unit.

Keywords

High-flow nasal cannula
Indication
Complication
Flow rate
Pneumothorax
Pediatric intensive care unit

Cited by (0)

1

HFNC = High-flow nasal cannula.

2

nCPAP = nasal continuous positive airway pressure.

3

PEEP = positive end-expiratory pressure.