title: High-flow nasal cannula: recommendations for daily practice in pediatrics.
abstract: High-flow nasal cannula (HFNC) is a relatively new device for respiratory support. In pediatrics, HFNC use continues to increase as the system is easily set up and is well tolerated by patients. The use of nasal cannula adapted to the infant's nares size to deliver heated and humidified gas at high flow rates has been associated with improvements in washout of nasopharyngeal dead space, lung mucociliary clearance, and oxygen delivery compared with other oxygen delivery systems. HFNC may also create positive pharyngeal pressure to reduce the work of breathing, which positions the device midway between classical oxygen delivery systems, like the high-concentration face mask and continuous positive airway pressure (CPAP) generators. Currently, most of the studies in the pediatric literature suggest the benefits of HFNC therapy only for moderately severe acute viral bronchiolitis. But, the experience with this device in neonatology and adult intensive care may broaden the pediatric indications to include weaning from invasive ventilation and acute asthma. As for any form of respiratory support, HFNC initiation in patients requires close monitoring, whether it be for pre- or inter-hospital transport or in the emergency department or the pediatric intensive care unit.
authors.affiliation: Département de Pédiatrie Néonatale et Réanimations, Pôle Universitaire Enfant, CHRU de Montpellier, Montpellier 34000, France ; Réanimation Pédiatrique, Hôpital Arnaud de Villeneuve, 371 avenue du doyen G. Giraud, Montpellier CEDEX 5, 34295, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Milési
authors.affiliation: Département de Pédiatrie Néonatale et Réanimations, Pôle Universitaire Enfant, CHRU de Montpellier, Montpellier 34000, France.
authors.forename: Mathilde
authors.initials: M
authors.lastname: Boubal
authors.affiliation: Département de Pédiatrie Néonatale et Réanimations, Pôle Universitaire Enfant, CHRU de Montpellier, Montpellier 34000, France.
authors.forename: Aurélien
authors.initials: A
authors.lastname: Jacquot
authors.affiliation: Département de Pédiatrie Néonatale et Réanimations, Pôle Universitaire Enfant, CHRU de Montpellier, Montpellier 34000, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Baleine
authors.affiliation: Département de Pédiatrie Néonatale et Réanimations, Pôle Universitaire Enfant, CHRU de Montpellier, Montpellier 34000, France.
authors.forename: Sabine
authors.initials: S
authors.lastname: Durand
authors.affiliation: Unidad de Cuidados Intensivos Pediatricos, Hospital Universitario Sant Joan de Deu, Universitat de Barcelona, Esplugues de Llobregat, Barcelona 08950, Spain.
authors.forename: Marti Pons
authors.initials: MP
authors.lastname: Odena
authors.affiliation: Département de Pédiatrie Néonatale et Réanimations, Pôle Universitaire Enfant, CHRU de Montpellier, Montpellier 34000, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Cambonie
keywords: Asthma; Bronchiolitis; High-flow nasal cannula; PICU