Use of high flow nasal cannula oxygen therapy in infants and children

Question 1

What are contraindications to HFNC?

Answer 1

• contraindications:
  
  • nasal obstruction
  • epistaxis
  • severe upper airway obstruction

Question 2

What are side effects of HFNC?

Answer 2

• excessive gas flow rates can impede exhalation in some patients with increased airway resistance
• higher intrathoracic pressures can reduce preload or increase pulmonary ventricular afterload - leading to hemodynamic instability
• air-leak syndrome
• abdominal distention
• third-spacing in facial trauma or following upper airway or esophageal surgery

Question 3

What clinical conditions are potentially responsive to HFNC?

Answer 3

Upper airway obstruction
* OSA

Lower airway obstruction

• bronchiolitis
• asthma

Lung parenchymal disease
* pneumonia or pneumonitis

Heart failure

Question 4

Why can a patient on HFNC have worsening respiratory distress?

Answer 4

HFNC can worsen resp distress in some patients due to breath-stacking or auto-PEEP. Decrease flow rates in these cases.