High-flow nasal cannula oxygen in acute respiratory post-extubation failure in pediatric patients: Key practical topics and clinical implications

Abstract

Optimal oxygen supply is the cornerstone of treatment of patients in critical condition, especially in patients at high risk of extubation failure. A high-flow nasal cannula is a relatively new device for delivery of heated and humidified medical gas mixtures at flow rates that exceed a patient’s inspiratory flow rate (Pilar et al., High flow oxygen therapy and continuous positive airway pressure. In: Medina A (ed) Non-invasive ventilation in pediatrics, pp 53–60, 2014; Lee et al. Intensive Care Med 39:247–257, 2013). The use of this device has been associated with improvements in washout of nasopharyngeal dead space; reduction of the inhalation resistance related to the passage of air through the nasopharyngeal airway; improvement in pulmonary compliance and elasticity compared with dry, cold gas; lung mucociliary clearance; and a certain degree of distending pressure for alveolar recruitment (Dysart et al. Respir Med 103:1400–1405, 2009). There are many experiences in the use of this device, mainly in neonatology and adult intensive care, including weaning from invasive ventilation.