High Flow Nasal Cannula Therapy In the Pediatric Home Setting

Introduction

High flow nasal cannula (HFNC) therapy is non-invasive respiratory support designed to deliver a high flow of heated humidified air, via purpose-designed nasal prongs. The application of this technology is rapidly spreading to include pediatric patients with various indications. Since it appears to be better tolerated than traditional modes of non-invasive ventilation, It`s increasingly used outside the intensive care setting, despite limited evidence of its safety and efficacy.

Methods

Medical records of children aged 0-18 years, commenced on domestic HFNC therapy at a tertiary center, Schneider Children’s Medical Center of Israel, between 2014-2018 were reviewed retrospectively. Demographic and clinical data were collected. Supplemental data about safety,and parental satisfaction (scale 1-5), obtained via a standardized telephone questionnaire.

Results

47 children (29 males, 18 females) were identified. Median age (range) of initiating home HFNC was 10.5 months (0.6-238). Indications for HFNC therapy included airway malacia (n=16, 34%), OSA (n=14,30%), neuromuscular disease (n=6,13%), aspiration lung disease (n=6, 13%), post extubation support (n=3,6%) and chronic lung disease of prematurity (n=2, 4%).

Comparing six months pre and post HFNC introduction, there was significant weight gain in the entire population (z score -2.3 pre, -1.4 post; p<0.001). There was no major adverse event in any of the patients. Parental mean satisfaction score was 4.7 (SD=0.5).

Conclusions

Domestic use of HFNC in children is safe and well tolerated a variety of indications. In our sample, it was associated with improved weight gain, a reduction of hospitalization days for the OSA subgroup and high parental satisfaction