Table 2.
Clinical indications for high-flow nasal cannula therapy in pediatric patients
| Disease, conditions | Study | Study design | Subjects characteristics | Main results |
|---|---|---|---|---|
| Bronchiolitis | Kepreotes, [12] 2017 | RCT, high flow (1 L/min/kg) vs. standard flow (2 L/min) | N=202, <24 months, moderate bronchiolitis | - Lower rate of treatment failure in HFNC group |
| - No differences in duration of oxygen therapy and ICU transfer | ||||
| Franklin, [13] 2018 | RCT, high flow (2 L/min/kg) vs. standard flow (2 L/min) | N=1,472, <12 months, mode- rate bronchiolitis | - Lower rate of treatment failure in HFNC group | |
| - No differences in duration of oxygen therapy, hospital stay, and ICU transfer | ||||
| Milesi, [14] 2018 | RCT, high flow (2 L/min/kg) vs. high flow (3 L/min/kg) | N=286, <6 months, moderate to severe bronchiolitis | - No differences in the rate of treatment failure | |
| - More discomfort in group with 3 L/kg/min | ||||
| Lin, [19] 2019 | Systematic review, 9 RCTs, HFNC vs. other oxy gen therapies (SOT, nCPAP) | N=2,121 | vs. SOT and nCPAP | |
| - No differences in length of stay, duration of oxygen therapy, ICU transfer, intubation rate, respiratory rate, SpO2 and adverse events | ||||
| - Significant reduction of the treatment failure (RR, 0.50; 95% CI, 0.40–0.62) compared with SOT group | ||||
| - Significant increase of the treatment failure (RR, 1.61; 95% CI, 1.06–2.42) compared with nCPAP group | ||||
| - Significant decreased of length of stay compared with SOT group in low-income and middle-income countries | ||||
| Asthma | Baudin, [20] 2017 | Retrospective observational study, HFNC vs. SOT | N=73, 1–18 years, ICU patients with status asthmaticus | - Improvement in pH, pCO2, heart rate, respiration rate, and oxygenation in HFNC group compared to SOT group |
| Ballestero, [21] 2018 | Prospective randomized pilot trial, HFNC vs. SOT | N=62, 1–14 years, ED patients with moderate-to-severe asthma exacerbation | - At 2 hours after the start of therapy, improvement in pulmonary score in HFNC group compared to SOT group | |
| Obstructive apnea/hypopnea | Hawkins, [25] 2017 | Observational study, HFNC 10–50 L/min | N=10, 1–18 years old, OSAS and CPAP intolerance | - Improvement in obstructive apnea-hypopnea index, SPO2, and heart rate in CPAP-intolerant children |
| Joseph, [26] 2015 | Retrospective review | N=5, 2 months–15 years, OSAS and CPAP intolerance | - Improvement in apnea-hypopnea index and nadir oxygen saturation | |
| Postextubation | Shioji, [27] 2017 | Retrospective observational study, pre-HFNC vs. post-HFNC | N=20, <48 months, postextubation respiratory failure after cardiac surgery | - Improvement in respiration rate after HFNC apply |
| Akyıldız, [28] 2018 | RCT, HFNC vs. conventional oxygen therapy | N=100, 1 month–18 years, ICU patients after extubation | - Improvement in respiration rate, heart rate, end-tidal CO2, and atelectasis in HFNC group | |
| - Lower failure rate of extubation in HFNC group | ||||
| Pneumonia | Chisti, [29] 2015 | Open RCT, HFNC vs. bubble CPAP vs. low-flow oxygen | N=225, <5 years old, severe pneumonia and hypoxemia | - No difference in the treatment failure after more than 1 hour of treatment between children with HFNC and bubble CPAP |
| - Study was early stopped because of higher mortality in the low-flow oxygen group | ||||
| Respiratory distress | Vitaliti, [30] 2017 | Prospective observational study, HFNC vs. helmet CPAP | N=60, 1–24 months, bronchiolitis (n=31), pneumoni a (n=7), asthma (n=2) | - Improvement of respiratory distress both HFNC and helmet CPAP group, but helmet CPAP was more efficient and rapid compared with HFNC |
RCT, randomized controlled trial; HFNC, high-flow nasal cannula; ICU, intensive care unit; SOT, standard oxygen therapy; nCPAP, nasal continuous positive airway pressure; CI, confidence interval; ED, Emergency Department; RR, risk ratio; OSAS, obstructive sleep apnea syndrome.