Pediatric emergency medicine trisk 0166 0166
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High-Flow Nasal Cannula
High-flow nasal cannula (HFNC) devices deliver oxygen at rates that match or
exceed patients’ inspiratory flow rates (up to as high as 60 L/min in adults),
resulting in a higher concentration of oxygen (FiO2 ) due to limited entrainment
of room air. HFNC can deliver an FiO2 from 21% to 100%, with heated and
humidified air being well tolerated. Nasal cannulas come in sizes for neonatal,
pediatric, and adult use. The flow should be adjusted based on patient age ( Table
8.2 ). If adequate respiratory support can be achieved with HFNC devices, the
need for sedation and risk of ventilator-associated pneumonia associated with
endotracheal intubation and mechanical ventilation can be avoided. In addition,
HFNC devices may be better tolerated than face masks by pediatric patients
because they are less constricting and permit speaking and feeding. HFNC has an
excellent safety profile, with only case-reportable complications related to
barotrauma (pneumothorax, pneumomediastinum, pneumocephalus).
TABLE 8.2
SUGGESTED FLOW RATES FOR HIGH-FLOW NASAL CANNULA
(HFNC)
Patient weight (kg)
Starting flow (L/min)
Maximum flow (L/min)
<5
5–10
10–20
20–40
>40
6
8
15–20
25–30
25–30
8
15
20
40
40–60
Noninvasive Ventilation
NIV encompasses mechanical respiratory support without endotracheal intubation
through either continuous positive airway pressure (CPAP) or bilevel positive
airway support (BPAP). CPAP provides a constant distending airway pressure
throughout the respiratory cycle. BPAP provides two levels of pressure referred to
as inspiratory positive airway pressure (IPAP) and expiratory positive airway
pressure (EPAP). Breaths can be synchronized to spontaneous respiratory effort
or delivered independently. Both CPAP and BPAP can be delivered through a
range of interfaces, including nasal cannula, nasal mask, full-face mask, or
helmet. Choosing an appropriate interface is often the greatest challenge in
