Original ArticlesThe Relationship between High Flow Nasal Cannula Flow Rate and Effort of Breathing in Children
Section snippets
Methods
We performed a single-center prospective trial in the 24-bed multidisciplinary medical-surgical pediatric intensive care unit at Children's Hospital Los Angeles (CHLA) from September 2014 to June 2016. This study was approved by the CHLA institutional review board, and informed consent was obtained. All patients ≤3 years of age admitted to the CHLA pediatric intensive care unit and placed on HFNC by the clinical team were eligible. We excluded patients if they had a corrected gestational age
Results
A total of 54 patients meeting inclusion criteria were approached, and 21 patients were consented and studied for a total of 49 titration episodes. Demographic and clinical characteristics were recorded (Table) and patients screened and studied are described in a CONSORT diagram (Figure 2; available at www.jpeds.com). The most common reason consent was refused was related to placement of the esophageal catheter.
Analyzing all titration episodes on all types of HFNC delivery systems, the median
Discussion
Using esophageal manometry to capture a direct metric of effort of breathing (PRP), we have demonstrated that increasing weight-indexed flow rates of HFNC (up to 2.0 L/kg/minute) decrease effort of breathing in a dose-dependent fashion with the largest effect seen in lighter children.
In the setting of respiratory illness, patients increase effort of breathing to maintain ventilation and oxygenation and compensate for changes in airway resistance and pulmonary compliance. Fundamentally,
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Cited by (58)
High-Flow Nasal Cannula Reduces Effort of Breathing But Not Consistently via Positive End-Expiratory Pressure
2022, ChestCitation Excerpt :Together, these findings oppose the hypothesis that HFNC improves effort of breathing primarily through the alveolar PEEP application. Our findings corroborate previous reports showing that higher doses of HFNC reduce effort of breathing within the clinical range of 0.5 to 2 L/kg/min.3,10 We showed that the reduction in effort of breathing with increasing HFNC dose does not seem to be related consistently to improvements in lung compliance, PesPEEP, or Vt, despite a median increase in EELV.
Mechanical Ventilation and Respiratory Support in the Pediatric Intensive Care Unit
2022, Pediatric Clinics of North AmericaCitation Excerpt :Although there is no consensus regarding the ideal initial gas flow rate, weight-based flow dosing is preferred, at least in infants.8 Modest respiratory support is achieved with flow rates between 0.5 and 1 L/kg/min, whereas flows up to 2 L/kg/min further attenuate intrathoracic pressure swings associated with work of breathing and likely represent maximal support.14 Flows in excess of 2 L/kg/min are unlikely to yield additional clinical benefit.15
Reply
2021, Journal of Pediatrics
Vapotherm, Inc. provided a limited number of high flow nasal cannula delivery systems for use in this study but this company did not have any role in (1) study design, (2) collection, analysis, and interpretation of data, (3) the writing of the report, or (4) the decision to submit the paper for publication. The authors declare no conflicts of interest.