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High flow nasal cannula therapy as respiratory support in the preterm infant†

  1. Carlo Dani MD1,*,
  2. Simone Pratesi MD1,
  3. Claudio Migliori MD2,
  4. Giovanna Bertini MD1

Article first published online: 4 JUN 2009

DOI: 10.1002/ppul.21051

Issue

Pediatric Pulmonology

Pediatric Pulmonology

Volume 44, Issue 7, pages 629–634, July 2009

Additional Information

How to Cite

Dani, C., Pratesi, S., Migliori, C. and Bertini, G. (2009), High flow nasal cannula therapy as respiratory support in the preterm infant. Pediatric Pulmonology, 44: 629–634. doi: 10.1002/ppul.21051

Author Information

  1. 1

    Division of Neonatology, Department of Surgical and Medical Critical Care, Careggi University Hospital of Florence, Florence, Italy

  2. 2

    Department of Neonatology, Spedali Civili, Brescia, Italy

*Division of Neonatology, Careggi University Hospital, University of Florence School of Medicine, Viale Morgagni, 85 Firenze, Italy.

  1. †

    The authors declare that they have no conflict of interest with the content of present article.

Publication History

  1. Issue published online: 23 JUN 2009
  2. Article first published online: 4 JUN 2009
  3. Manuscript Accepted: 25 MAR 2009
  4. Manuscript Revised: 2 MAR 2009
  5. Manuscript Received: 23 JAN 2009

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Keywords:

  • high flow nasal cannula;
  • continuous positive airway pressure;
  • oxygen delivery;
  • infant

Abstract

We reviewed the literature on the effects of high flow nasal cannula (HFNC) and heated, humidified, high-flow, nasal cannula (HHHFNC) treatment in preterm infants. We found nine studies, but only two were randomized controlled trials. These studies show that: HFNC application is associated to the delivery of continuous distending pressure (CDP) in patients with closed mouth, whose value is proportional to the delivered flow only in smaller infants; the CDP delivered by HFNC is unpredictable and present large inter-patient and intra-patient variability; the use of recently available HHHFNC devices is effective in minimizing nasal mucosa injuries compared to traditional HFNC; the effectiveness of HHHFNC versus NCPAP for the treatment of apnoea of prematurity, respiratory distress syndrome, and the prevention of extubation failure, has been poor investigated and firm conclusions cannot be drawn on this matter. In conclusion, on the basis of published data, the routinary application of HFNC should be limited to patients requiring oxygen-therapy, HHHFNC devices should be preferred to HFNC, but their employment as an alternative to NCPAP should wait for the conclusion of randomized controlled trials. Pediatr Pulmonol. 2009; 44:629–634. © 2009 Wiley-Liss, Inc.

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