HIGH-FLOW NASAL CANNULA (HFNC) THERAPY FOR NEONATES
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Tóm tắt
High-Flow Nasal Cannula (HFNC) therapy is a non-invasive respiratory support method that delivers a blend of air and oxygen at flow rates equal to or exceeding the patient’s inspiratory demand. It helps reduce the work of breathing, provides positive end-expiratory pressure (PEEP), washes out dead space, and preserves the respiratory mucosa using heated and humidified gas. The gas flow rate provided to the patient can range from 2 to 60 L/min.
The first High-Flow (HFNC) delivery devices were introduced around the 2000s, and several studies on the application of HFNC showed a significant reduction in intubation rates among children in pediatric intensive care and neonatal emergency units.
Many scientific studies and clinical practice guidelines on HFNC from medical societies worldwide, such as the European Respiratory Society [1], the European Society of Intensive Care Medicine [2], and the American Association for Respiratory Care [3], have been published. Guidelines from these global societies agree on the efficacy, timing of use, and benefits of HFNC in reducing intubation rates or facilitating early weaning from mechanical ventilation in respiratory diseases, thereby reducing hospital length of stay and treatment costs.
A study using HFNC on 298 children under 24 months of age with bronchiolitis, upper airway obstruction, and cardiovascular/neuromuscular diseases showed a reduction in the intubation rate in the Intensive Care Unit from 37% to 7% [4].
Another study in the US on 848 children with a mean age of 4.6 years suffering from bronchiolitis showed a reduction in intubation rates from 11% to 2% [5].
Several randomized controlled trials (RCTs) have compared the efficacy of HFNC and CPAP following extubation in neonates.
Conclusions from these studies suggest that HFNC can replace CPAP when the infant is clinically stable but still requires respiratory support greater than low-flow oxygen.
Studies comparing HFNC and CPAP in the initial management of respiratory distress immediately after birth show that CPAP has a lower treatment failure rate compared to HFNC when used as primary support; however, the indication for intubation in both groups was equivalent.
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Tài liệu tham khảo
2. Oczkowski S, Ergan B, Bos L et al. ERS clinical practice guidelines: high-flow nasal cannula in acute respiratory failure. Eur Respir J 2022;59(4):2101574. https://doi. org/10.1183/13993003.01574-2021
3. Piraino T, Madden M, Roberts KJ et al. AARC Clinical Practice Guideline: Management of Adult Patients With Oxygen in the Acute Care Setting. Respir Care 2022;67(1):115-128. https://doi.org/10.4187/respcare.09294
4. Schibler A, Pham TMT, Dunster KR et al. Reduced intubation rates for infants after introduction of high-flow nasal prong oxygen delivery. Intensive Care Med 2011;37(5):847- 52. https://doi.org/10.1007/s00134-011-2177-5
5. Wing R, James C, Maranda LS et al. Use of high-flow nasal cannula support in the emergency department reduces the need for intubation in pediatric acute respiratory insufficiency. Pediatr Emerg Care 2012;28(11):1117-23. https://doi. org/10.1097/pec.0b013e31827122a9
6. Franklin D, Babl FE, Schlapbach LJ et al. A Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitis. N Engl J Med 2018;378(12):1121-1131. https://doi. org/10.1056/nejmoa1714855