title: Is there a role for humidified heated high-flow nasal cannula therapy in paediatric emergency departments?
abstract: BACKGROUND
  Humidified heated high-flow nasal cannula (HFNC) therapy is a potentially useful form of non-invasive respiratory support for children with moderate respiratory distress and/or hypoxaemia. No prospective data support its use in the paediatric emergency department (ED). We introduced HFNC therapy into a paediatric ED and evaluated its use and failure rates.
  
  
  METHODS
  Prospective observational study of all patients presenting to the Royal Children's Hospital, Australia, who received HFNC therapy between April 2013 and September 2013 (one southern hemisphere winter season). We assessed demographics, indications, failure rate, predictors of failure and adverse events.
  
  
  RESULTS
  71 patients commenced HFNC therapy in ED over the study period. The median age was 9 months. The most common indication was bronchiolitis (49/71; 69%). Five (7%) of the patients failed HFNC and were escalated to other forms of respiratory support in ED, four to nasal continuous positive airway pressure and one required intubation. A further 21 (32%) failed HFNC therapy after intensive care unit (ICU) admission, giving a total failure of 28 (39%). There were no serious adverse events in ED, and one child with asthma developed air leak syndrome after transfer to the ICU.
  
  
  CONCLUSIONS
  HFNC therapy may have a role in the paediatric ED as an easily administered and well tolerated form of non-invasive respiratory support, but about one-third of patients required escalation to a higher level of respiratory support. Further studies should assess the safety profile of HFNC in larger series, and define the role of HFNC in key respiratory conditions compared with other possible interventions.
authors.affiliation: Department of Emergency Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia Murdoch Children's Research Institute, Parkville, Victoria, Australia Department of Paediatrics, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Elliot
authors.initials: E
authors.lastname: Long
authors.affiliation: Department of Emergency Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia Murdoch Children's Research Institute, Parkville, Victoria, Australia Department of Paediatrics, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Franz E
authors.initials: FE
authors.lastname: Babl
authors.affiliation: Murdoch Children's Research Institute, Parkville, Victoria, Australia Department of Paediatrics, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Parkville, Victoria, Australia Paediatric Intensive Care Unit, The Royal Children's Hospital, Parkville, Victoria, Australia.
authors.forename: Trevor
authors.initials: T
authors.lastname: Duke
mesh_terms: D001315:Australia; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D006813:Humidity; D007223:Infant; D008297:Male; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D000070316:Pediatric Emergency Medicine / Q000379:methods*; D011446:Prospective Studies; D012140:Respiratory Tract Diseases / Q000628:therapy*
keywords: emergency department; paediatrics, paediatric emergency medicine; respiratory; ventilation, non invasive