The use of high-flow nasal cannula (HFNC) as respiratory support in neonatal and pediatric intensive care units in Germany - A nationwide survey

Abstract

Background: High-flow nasal cannula (HFNC)¹ is a technique of oxygen supply, initially being used as a potentially less-invasive alternative to nasal continuous positive airway pressure (nCPAP)² for premature infants/neonates, which nowadays crosses the border of neonatal care. HFNC builds up a positive end-expiratory pressure (PEEP)³ but lacks the opportunity for continuous monitoring. Therefore, pressure-depending complications are a risk. Our goal was to evaluate the current use of HFNC in Germany regarding indications, techniques of application and complications experienced.

Studydesign: We used a questionnaire sent to 226 pediatric clinics.

Results: We received responses from 67 pediatric clinics (29.6%). HFNC was applied in the age group of 8 to 14 years in 42% and between 14 and 18 years in 33% of the clinics. 54% of the clinics have been using HFNC for more than 3 years. Applied flow rates varied strongly among the clinics. 70% of the clinics use HFNC outside of the established indications (alternative to nCPAP for premature infants and neonates, bronchiolitis) for pneumonia, support after extubation and non-adherence to nCPAP. Severe complications such as pneumothorax have been seen by 17,9% of the clinics.

Conclusion: We reported for the first time a nationwide overview about the expanded use of HFNC in pediatric clinics. Our results emphasize the fact that, even though HFNC is widely accepted as a non-invasive procedure there is still a potential of severe side effects. Therefore the use of HFNC should be monitored continuously and closely within an intensive or intermediate care unit.

Keywords: Complication; Flow rate; High-flow nasal cannula; Indication; Pediatric intensive care unit; Pneumothorax.