title: Modalities and Complications Associated With the Use of High-Flow Nasal Cannula: Experience in a Pediatric ICU.
abstract: BACKGROUND
  High-flow nasal cannula (HFNC) therapy is increasingly used in pediatric ICUs as an intermediate level of support between conventional oxygen delivery and noninvasive ventilation (NIV). The safety of HFNC has seldom been studied, and some cases of barotrauma have been reported. This retrospective study aims to describe HFNC use in a tertiary care pediatric ICU, with a focus on the complications associated with this therapy.
  
  
  METHODS
  Between January 2013 and January 2014, all children <18 y old treated with HFNC in the pediatric ICU were included. Demographic data, HFNC settings, chest radiograph reports, and blood gas values were gathered from the electronic medical records. Episodes of pneumothorax, pneumomediastinum, and significant epistaxis were noted. Pneumothorax was distinguished from chest tube-related air leak (frequent after cardiac surgery), which was defined as a small pneumothorax with no clinical impact that resolved spontaneously after chest tube removal.
  
  
  RESULTS
  During the 1-y study period, there were 177 HFNC episodes, involving 145 subjects with a median (interquartile range) age of 8 (2-28) months. HFNC was used as primary support in 31% of episodes, after extubation in 36% and after NIV in 18%. HFNC was administered exclusively for nitric oxide delivery in 16% of episodes. Two children (1%) developed new pneumothoraces that required chest tube insertion, whereas 5 (3%) chest tube-related air leaks were noted. One (0.6%) episode of significant epistaxis was noted. Among 6 preexisting pneumothoraces, none worsened under HFNC. Failure of HFNC occurred in 32 episodes, requiring transition to NIV in 28 cases and endotracheal intubation in 5 cases.
  
  
  CONCLUSIONS
  Support with HFNC following a clinical protocol in pediatric ICUs was associated with a relatively low rate of complications. Since HFNC use is increasing, further evidence is needed to confirm its efficacy and safety.
authors.affiliation: Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada. Pediatric Intensive Care Unit, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Bron, France.
authors.forename: Florent
authors.initials: F
authors.lastname: Baudin
authors.affiliation: Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Gagnon
authors.affiliation: Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Crulli
authors.affiliation: Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: François
authors.initials: F
authors.lastname: Proulx
authors.affiliation: Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Jouvet
authors.affiliation: Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada. guillaume.emeriaud@umontreal.ca.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Emeriaud
mesh_terms: D060666:Airway Extubation / Q000009:adverse effects; D000072601:Cannula / Q000009:adverse effects*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data*; D008297:Male; D063087:Noninvasive Ventilation / Q000706:statistics & numerical data*; D010102:Oxygen Inhalation Therapy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D011030:Pneumothorax / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: barotrauma; children; complications; high-flow nasal cannula; noninvasive ventilation; pediatric ICU; pneumothorax