HWN Suggests

Does high flow prevent the risk of intubation in bronchiolitis? Not so fast!

High Flow, High Flow, it’s off to work we go. Let’s give some CPAP and… stop singing. OK, anyway, as a follow up to yesterday’s article on standard oxygen therapy I wanted to dive into High Flow. It entails the delivery of heated and humidified oxygen via special devices (eg, Vapotherm®) providing up to 8 L/min in infants and up to 40 L/min in children and adults. It is generally delivered via nasal cannula and though hard to assess he exact amount in vivo, results in the generation of positive end expiratory pressure, thus stenting open the airways.

It is an advantageous modality in that it can deliver high FiO2 with lower flow rates that is more comfortable for the patient. The…

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Featured

  Pediatric Pocket Guide

The recommended flow rates for infants and toddlers under 20 kg is 2 L/min per kilogram of weight.

  Paris in the Autumn

This is the biggest and most robust trial yet done to assess the value of high-flow in bronchiolitis. The primary outcome shows that there is a role for high-flow in the non-ICU management of this disease.

 High-flow nasal cannula (Vapotherm) in bronchiolitis – the PARIS trial

The bottom line: High-flow nasal cannula is superior to standard oxygen therapy in bronchiolitis, with a NNT of 9.

 The use of high-flow nasal cannula in the pediatric emergency department

High-flow nasal cannula should be considered for pediatric emergency department patients with respiratory distress not requiring immediate endotracheal intubation; prospective, pediatric emergency department-specific trials are needed to better determine responsive patient populations, ideal high-flow nasal cannula settings, and comparative efficacy vs. other respiratory support modalities.

Articles of Interest

Pediatric Guidelines and Best Practices for High Flow Nasal Cannula (HFNC)

The Precision Flow system delivers heated and humidified gas at flow rates that exceed inspiratory demand and flush the respiratory dead space to reduce work of breathing.

High Flow Nasal Cannula Flow Rates: New Data Worth the Weight

Nevertheless, questions remain about this respiratory support modality. Does this level of support influence clinical outcomes compared with standard nasal cannula oxygen4 or noninvasive positive pressure ventilation?2 Are there patient-level factors that can predict the response to HFNC therapy? In what locations and under which circumstances can HFNC support be provided safely?

Resources

How to set up Vapotherm

The #EM3 team demonstrates the steps required to set up and apply a Vapotherm system in the Children's Emergency Department, Leicester Royal Infirmary.

Vapotherm

Vapotherm High Velocity Nasal Insufflation (Hi-VNI) provides clinically effective comfortable respiratory support through a simple nasal cannula. The Precision Flow system delivers heated and humidified gas at flow rates that exceed inspiratory demand and flush the respiratory dead space to reduce work of breathing.