Nasal high-flow oxygen delivery in children with abnormal airways
Related Experiment Video
Updated: Sep 29, 2026
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Susan Humphreys1,2, Derek Rosen1,2, Tessa Housden1,2
1Department of Anaesthesia, Lady Cilento Children's Hospital, South Brisbane, Qld, Australia.
Insights
Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (nasal high flow) safely maintains oxygenation in pediatric patients with abnormal airways during anesthesia. This technique is effective for tubeless airway procedures, reducing the need for rescue oxygenation.
Area of Science:
- Anesthesiology
- Pediatric Anesthesia
- Airway Management
Background:
- Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (nasal high flow) is an established method for apneic oxygenation in adults and children.
- This technique is increasingly used in pediatric anesthesia, particularly for patients at risk of apnea.
Purpose of the Study:
- To evaluate the efficacy of nasal high flow oxygen delivery in pediatric patients undergoing anesthesia for abnormal airway procedures.
- To assess outcomes in children requiring tubeless airway assessment or surgery.
Main Methods:
- Retrospective analysis of pediatric patients receiving nasal high flow during upper airway procedures.
- Patients categorized by indication: tubeless surgery, flexible bronchoscopy, anticipated difficult airway, or apnea risk.
- Anesthesia involved intravenous induction or sevoflurane, transitioning to total intravenous anesthesia with spontaneous ventilation, utilizing weight-based nasal high flow at 100% oxygen.
Main Results:
- Twenty children (5 days to 11 years) with ASA 1-4 status were analyzed.
- Average SpO2 was 96%, with a minimum of 77%; one patient required rescue oxygenation.
- The median procedure length was 32 minutes, with tubeless airway surgery being the most common indication.
Conclusions:
- Nasal high flow is a viable option for maintaining oxygenation in spontaneously breathing children with abnormal airways.
- It is effective during anesthesia for tubeless airway procedures in the pediatric population.
Background:
Transnasal Humidified Rapid-Insufflation Ventilatory Exchange has been shown to safely prolong the safe apnea time in well children post induction of anesthesia and is rapidly becoming a new standard for apneic oxygenation in adults. The same oxygenation technique is described as nasal high flow and can be used in infants and children at risk of apnea during anesthesia.
Aim:
We investigated the use of nasal high flow oxygen delivery during anesthesia in children with abnormal airways requiring tubeless airway assessment or surgery.
Methods:
Data and outcomes of pediatric patients receiving nasal high flow for upper airway procedures were analyzed. Four categories were defined: (i) tubeless airway surgery, (ii) flexible bronchoscopy, (iii) expected difficult airway, and (iv) comorbidity related risk of apnea. Anesthesia was induced intravenously or with sevoflurane (4-8%) and then converted to total intravenous anesthesia aiming for spontaneous ventilation. Age appropriate nasal high flow cannulae were secured with 100% oxygen delivery at weight-related flow rates. Topicalization of the airway was achieved with lignocaine. Complication rates of desaturation requiring interruption of procedure for rescue oxygenation were recorded.
Results:
Twenty children were analyzed with age range of 5 days to 11 years, ASA 1-4, and weight range 3-57 kg. Fifteen were induced with sevoflurane and 100% oxygen, five received total intravenous anesthesia only. All children received Optiflow™ nasal high flow and intravenous anesthesia during their procedure. Average SpO2 recorded was 96% with lowest SpO2 77%. One required rescue oxygenation. Median length of procedure was 32 min, (range 3-61). Most common indication was tubeless airway surgery but seven children had more than one indication.
Conclusion:
Nasal high flow can be used in spontaneously breathing children with abnormal airways for maintenance of oxygenation during anesthesia for tubeless airway procedures.
More Related Videos
05:46A Novel Inhalation Mask System to Deliver High Concentrations of Nitric Oxide Gas in Spontaneously Breathing Subjects
Published on: May 4, 2021
07:15Preoxygenation Techniques for Tracheal Intubation in Critically Ill Adults Utilizing Oxygen Mask and Noninvasive Ventilation
Published on: December 5, 2025
Related Concept Videos
01:26Oxygen Delivering System I: Nasal Cannula and Face Mask
Nasal Cannula
A nasal cannula is a lightweight tube split at one end into two prongs and placed in the nostrils. It is typically used to deliver low to medium levels of oxygen.
Suggested flow rate: The suggested flow rate for a nasal cannula typically ranges between 1 and 6 L/min.
Oxygen percentage setting:...
01:16Oxygen Delivering System II: Venturi Mask and Transtracheal Oxygen
Venturi Mask
The Venturi mask, named after the Venturi effect, is designed to deliver precise oxygen concentrations. It consists of a large tube with an oxygen inlet that narrows down, causing a pressure drop that pulls air in through adjustable side ports. The mask is a lightweight,...
01:29Administering Oxygen by Nasal Cannula
Nasal Cannulas
A nasal cannula is a lightweight tube split into two prongs placed in the nostrils, connected...
01:30Administering Oxygen by Mask
Administering oxygen by mask is a common nursing intervention that provides supplemental oxygen to patients with respiratory distress or chronic lung conditions. This procedure involves delivering oxygen at a specified rate through a face mask connected to an oxygen source.
Equipment
The equipment necessary for this procedure includes:
01:29Suctioning the Nasopharyngeal Airway
Equipment Required
01:22Cardiopulmonary Resuscitation II: ACLS Airway Management