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Effort of breathing in children receiving high-flow nasal cannula

Sarah Rubin1, Anoopindar Ghuman, Timothy Deakers

  • 11Departments of Pediatrics and Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA. 2Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|November 9, 2013
PubMed

Insights

High-flow humidified nasal cannula (HFHN) reduces the effort of breathing in critically ill children. Increasing flow rates from 2 to 8 L/min significantly lowers the work of breathing, suggesting improved respiratory support.

Area of Science:

  • Pediatric Critical Care Medicine
  • Respiratory Physiology
  • Noninvasive Ventilation

Background:

  • High-flow humidified nasal cannula (HFHN) is widely used for noninvasive respiratory support in children.
  • The precise mechanisms and objective impact of HFHN on respiratory effort in pediatric patients remain incompletely understood.

Purpose of the Study:

  • To objectively evaluate the effect of varying HFHN flow rates on the effort of breathing in critically ill children.
  • To elucidate the physiological mechanisms by which HFHN provides respiratory support.

Main Methods:

  • A prospective cohort study was conducted in a pediatric intensive care unit.
  • Esophageal pressure monitoring was used to measure pleural pressure changes (ΔPes) and respiratory rate.
  • The Pressure.Rate Product, an objective measure of respiratory effort, was calculated at HFHN flow rates of 2, 5, and 8 L/min.

Main Results:

  • Twenty-five pediatric patients were analyzed.
  • The Pressure.Rate Product significantly decreased with increasing HFHN flow rates (8 L/min < 5 L/min < 2 L/min).
  • Higher baseline pleural pressure was observed at 8 L/min compared to 2 L/min, indicating positive pressure generation.

Conclusions:

  • Increasing HFHN flow rates effectively reduce the effort of breathing in critically ill children.
  • The benefits are most pronounced between 2 and 8 L/min, likely due to positive airway pressure generation and dead space washout.
Abstract

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