Over the last decade heated humidified high flow oxygen therapy (HHHF) has become an increasingly important and popular mode of noninvasive respiratory support. HHHF facilitates delivery of humidified and heated oxygen at a high flow rate. This ensures that the sensation of flow in the patients' nose is a pleasant one which increases the likelihood of good compliance.
We present here three cases of children without adenotonsillar hypertrophy who failed the usual treatment for severe obstructive sleep apnea (OSA). A 28 month old ex-premature boy with severe FTT who could not tolerate CPAP but had a vast improvement on HHHF and started to thrive. A 15 year old boy with severe psychomotor retardation who was offered a tracheostormy due to severe OSA and had significantly improved symptoms with HHHF. Lastly a 3 year old girl with multiple anomalies including severe laryngomalacia causing OSA. She too improved with HHHF when CPAP was not tolerated because of her facial anatomy.
We discuss the potential mechanism of action of HHHF, its potential complications and why these are likely less relevant to patients with OSA.
