A Review of Heated High-Flow Nasal Cannula in Pediatrics—From Critical Care to Ward Use

Abstract

Heated high-flow nasal cannula (HFNC) is used in management of acute respiratory distress and is increasingly used in the emergency department (ED) and ward setting. This review aimed to highlight existing literature on ward use of HFNC. HFNC reduces work of breathing, increases mucociliary clearance, and improves oxygenation. Within limits, HFNC can be safely used on pediatric wards for management of moderate to severe respiratory distress. Weight-based and non-weight-based flow rates have been successfully used on pediatric wards, and maximum acceptable flow rates on wards are site and resource specific. Frequent monitoring can identify responders and non-responders requiring escalation. Early observation suggests that oral feeding is safe. Ward HFNC weaning protocols are lacking. Evidence suggests that in selected populations of children with moderate to severe respiratory distress due to acute bronchiolitis, HFNC with close monitoring is safe for use on the pediatric wards.