title: Use of high flow nasal cannula in critically ill infants, children, and adults: a critical review of the literature.
abstract: BACKGROUND
  High flow nasal cannula (HFNC) systems utilize higher gas flow rates than standard nasal cannulae. The use of HFNC as a respiratory support modality is increasing in the infant, pediatric, and adult populations as an alternative to non-invasive positive pressure ventilation.
  
  
  OBJECTIVE
  This critical review aims to: (1) appraise available evidence with regard to the utility of HFNC in neonatal, pediatric, and adult patients; (2) review the physiology of HFNC; (3) describe available HFNC systems (online supplement); and (4) review ongoing and planned trials studying the utility of HFNC in various clinical settings.
  
  
  RESULTS
  Clinical neonatal studies are limited to premature infants. Only a few pediatric studies have examined the use of HFNC, with most focusing on this modality for viral bronchiolitis. In critically ill adults, most studies have focused on acute respiratory parameters and short-term physiologic outcomes with limited investigations focusing on clinical outcomes such as duration of therapy and need for escalation of ventilatory support. Current evidence demonstrates that HFNC generates positive airway pressure in most circumstances; however, the predominant mechanism of action in relieving respiratory distress is not well established.
  
  
  CONCLUSIONS
  Current evidence suggests that HFNC is well tolerated and may be feasible in a subset of patients who require ventilatory support with non-invasive ventilation. However, HFNC has not been demonstrated to be equivalent or superior to non-invasive positive pressure ventilation, and further studies are needed to identify clinical indications for HFNC in patients with moderate to severe respiratory distress.
authors.affiliation: Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children's Hospital, Durham, NC, USA. leejanhau@gmail.com
authors.forename: Jan Hau
authors.initials: JH
authors.lastname: Lee
authors.forename: Kyle J
authors.initials: KJ
authors.lastname: Rehder
authors.forename: Lee
authors.initials: L
authors.lastname: Williford
authors.forename: Ira M
authors.initials: IM
authors.lastname: Cheifetz
authors.forename: David A
authors.initials: DA
authors.lastname: Turner
mesh_terms: D000328:Adult; D057785:Catheters; D002648:Child; D016638:Critical Illness; D006801:Humans; D007223:Infant; D063087:Noninvasive Ventilation / Q000295:instrumentation* / Q000379:methods*; D009666:Nose