High flow nasal cannula in the pediatric intensive care unit

Area of Science:

• Pediatric Critical Care Medicine
• Respiratory Support
• Evidence-Based Medicine

Background:

• High flow nasal cannula (HFNC) use is widespread in pediatric intensive care units (PICUs) globally.
• Rapid adoption has outpaced rigorous research on HFNC safety and efficacy in diverse pediatric conditions.
• Current evidence relies heavily on institutional practices and small observational studies.

Purpose of the Study:

• To define the mechanisms of action of HFNC.
• To review existing literature on HFNC use in critically ill children within PICUs.
• To identify gaps in research regarding HFNC efficacy and patient-centered outcomes.

Main Methods:

• A scoping review of the literature was conducted.
• The PubMed database was searched using a pediatric filter.
• Literature from 2000 to 2021 was included.

Main Results:

• Significant lack of adequately powered studies evaluating patient-centered outcomes (e.g., intubation rates, mortality, length of stay).
• Wide variability exists in HFNC flow rates and clinical indications, necessitating further research.
• Limited data exists on HFNC use in specific conditions like pediatric acute respiratory distress syndrome (PARDS).

Conclusions:

• More research is crucial to define optimal HFNC flow rates for different pediatric disease states.
• There is a need for studies establishing clear markers for HFNC treatment success and failure.
• Further investigation into HFNC's role in conditions such as PARDS is warranted.