The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

SAFETY AND EFFICACY OF HIGH FLOW NASAL CANNULA AND ITS USE IN THE NEONATAL INTENSIVE CARE UNIT

Matthew S. Pavlichko1,2, Ronald S. Sherman1, Gerard Brown2; 1Respiratory Care Services, The Reading Hospital and Medical Center, West Reading, PA; 2Neonatal Intensive Care Unit, The Reading Hospital and Medical Center, West Reading, PA

Background: The safety and efficacy of high flow nasal cannula (HFNC) has been a debated topic among clinicians for many years. HFNC uses optimally humidified oxygen which allows the clinician to turn up the flow. The higher flow applies a “splinting” affect to the airway which reduces the occurrence and severity of apneic events and work of breathing. The clinical dilemma is the unknown potential adverse events related to this therapy. Method: Over a nine month period, 69 infants were enrolled into the study with greater than 10,000 hours of HFNC therapy. Patient monitoring, quality assurance, and chart reviews were performed to look for adverse events of HFNC. The adverse events that were closely examined were pneumothoraces, infection, nasal dryness, and abdominal distention. A Teleflex Neptune humidifier with a single limb heated wire circuit was used and confirmed to deliver the high flow oxygen at optimal humidity (100% RH, BTPS). A Precision Medical oxygen blender and Hudson oxygen analyzer were used to guarantee flow rates and FiO2 delivered. Physicians ordered variable flow rates ranging in 1-5 lpm based on clinical need for respiratory support. Results: Patient indications for therapy included: Increased apneas, desaturations, or WOB (n=26); progressive weaning from ventilator assistance or NCPAP to bubble humidifier nasal cannula (n=41); or, the need for less invasive support with evidence of pneumothorax (n=2). Pneumothoraces occurred in only two of our study patients on HFNC. Two other patients resolved their previously diagnosed pneumothoraces while on HFNC. There was no evidence of airway infection. Five infants showed signs of nasal dryness, which was relieved with nasal saline drops. Three patients demonstrated abdominal distention, but it was relieved in two of the patients after NCPAP or NIPPV was switched to HFNC. Of the 69 patients enrolled, 25 (36.2%) demonstrated signs of apnea of prematurity, desaturations, and/or bradycardia. Of those patients, 12 required therapies such as assisted ventilation with surfactant administration (n=4), NCPAP (n=5), NIPPV (n=2), and oxygen hood (n=1), that are considered more invasive or restrictive than HFNC. Conclusion: This study demonstrated that high flow rate, heated, humidified nasal cannula is a well tolerated, safe, and effective adjunct therapy. It decreases respiratory distress and apneas, while filling the gap between NCPAP and bubble humidified oxygen. Sponsored Research - None

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