title: Serious air leak syndrome complicating high-flow nasal cannula therapy: a report of 3 cases.
abstract: Despite the absence of clinical safety data, heated, humidified high-flow nasal cannula (HHFNC) therapy is increasingly being used as an alternative to positive-pressure ventilation in pediatrics. This use of HHFNC is "off label" because the US Food and Drug Administration's approval for these devices was only for air humidification and not as a modality to provide positive distending pressure. For the first time we describe 3 cases who developed serious air leaks related to HHFNC therapy. The first child was a previously healthy 2-month-old male infant with respiratory syncytial virus bronchiolitis who developed a right pneumothorax on day 5 of his illness at 8 liters per minute (lpm). He subsequently required intubation and ventilation for 14 days. The second case involved an otherwise healthy 16-year-old boy with cerebral palsy who developed pneumomediastinum and died of its complications. He was receiving 20 lpm HHFNC therapy when he developed pneumomediastinum. The third case involved a 22-month-old, previously healthy boy who developed subdural hematoma secondary to abuse. He developed a right pneumothorax while receiving HHFNC at a flow of 6 lpm, requiring chest tube placement. These cases emphasize the need for extreme caution while using HHFNC for the off-label indication of providing positive distending pressure in children, especially at flows higher than the patient's minute ventilation. A more detailed study to specifically look at the serious adverse events related to HHFNC is urgently needed.
authors: Division of Pediatric Pulmonary Medicine, Department of Pediatrics, University of Florida, Gainesville, FL 32610, USA. hegdes@ufl.edu
authors: Satyanarayan
authors: S
authors: Hegde
authors: Parthak
authors: P
authors: Prodhan
mesh_terms: D000293:Adolescent; D057785:Catheters / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D008297:Male; D011030:Pneumothorax / Q000175:diagnosis* / Q000209:etiology*; D011175:Positive-Pressure Respiration / Q000009:adverse effects* / Q000379:methods; D013577:Syndrome