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High Flow Evidence

Main Findings
A comparative in vitro study of standard facemark jet nebulisation and high-flow nebulisation in bronchiolitis
Experimental Lung Research
The use of a nebulizer integrated with HFNC has shown promising results in an experimental scenario of bronchiolitis. The particle size achieved with the nebulizer placed before the humidifier is equivalent to the one obtained via conventional nebulization, and it is even smaller when the integrated nebulizer is placed before the nasal cannulas
Basic and modern practice of nasal high-flow therapy
Uni-Med Publishers
Current essentials around the use of HF
Rational use of high-flow therapy in infants with bronchiolitis. What do the latest trials tell us?’ A Paediatric Research in Emergency Departments International Collaborative perspective
J Paed and Child Health
The findings of this review suggest that HFNC should be used as a rescue treatment for hypoxaemic infants who have not responded to standard sub nasal oxygen therapy. The use of HFNC for work of breathing in the absence of hypoxaemia, and severe disease, is not currently supported by the evidence
Transnasal Humidified Rapid Insufflation Ventilatory Exchange in children requiring emergent intubation (Kids THRIVE): a protocol for a randomised controlled trial
Protocol for THRIVE in emergency situations
FIRST-line support for Assistance in Breathing in Children (FIRST-ABC): a MC pilot RCT of high-flow nasal cannula therapy versus continuous positive airway pressure in paediatric critical care.
Crit Care
Our pilot trial confirms that, following minor changes to consent procedures and treatment algorithms, it is feasible to conduct a large national RCT of non-invasive respiratory support in the paediatric critical care setting in both step-up and step-down NRS patients.
A Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitis.
Among infants with bronchiolitis who were treated outside an ICU, those who received high-flow oxygen therapy had significantly lower rates of escalation of care due to treatment failure than those in the group that received standard oxygen therapy.
A multicenter randomized controlled trial of a 3-L/kg/min versus 2-L/kg/min high-flow nasal cannula flow rate in young infants with severe viral bronchiolitis
Intensive Care Med
In young infants with AVB supported with HFNC, 3 L/kg/min did not reduce the risk of failure compared with 2 L/kg/min.
High-flow warm humidified oxygen versus standard low-flow nasal cannula oxygen for moderate bronchiolitis (HFWHO RCT): an open, phase 4, randomised controlled trial.
HFWHO did not significantly reduce time on oxygen compared with standard therapy, suggesting that early use of HFWHO does not modify the underlying disease process in moderately severe bronchiolitis. HFWHO might have a role as a rescue therapy to reduce the proportion of children requiring high-cost intensive care.
High flow nasal cannula (HFNC) versus nasal continuous positive airway pressure (nCPAP) for the initial respiratory management of acute viral bronchiolitis in young infants: a multicenter randomized controlled trial
Intensive Care Med
In infants with moderate to severe AVB, initial management with HFNC did not have a failure rate similar to that of nCPAP. Relative risk of success 1.63 (95% CI 1.02-2.63) higher with nCPAP.
Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) in children: a randomized controlled trial
Br J Anaesthesia
Transnasal humidified rapid-insufflation ventilatory exchange prolongs the safe apnoea time in healthy children but has no effect to improve CO2 clearance
Effect of Postextubation High-Flow Nasal Cannula vs Noninvasive Ventilation on Reintubation and Postextubation Respiratory Failure in High-Risk Patients: A Randomized Clinical Trial.
Among high-risk adults who have undergone extubation, high-flow conditioned oxygen therapy was not inferior to NIV for preventing reintubation and postextubation respiratory failure. High-flow conditioned oxygen therapy may offer advantages for these patients.
Effect of Postextubation High-Flow Nasal Cannula vs Conventional Oxygen Therapy on Reintubation in Low-Risk Patients: A Randomized Clinical Trial.
Among extubated patients at low risk for reintubation, the use of high-flow nasal cannula oxygen compared with conventional oxygen therapy reduced the risk of reintubation within 72 hours.
The effect of high flow nasal cannula therapy on the work of breathing in infants with bronchiolitis.
Paediatr Pulmonology
HFNC offloads the diaphragm and reduces the WOB in bronchiolitis as measured by RIP and diaphragmatic EMG
Physiologic effect of high-flow nasal cannula in infants with bronchiolitis.
Pediatr Crit Care Med
In infants with bronchiolitis, high-flow nasal cannula oxygen/air delivered at 8 L/min resulted in increases in end-expiratory lung volume and improved respiratory rate, FIO2, and SpO2.
Is treatment with a high flow nasal cannula effective in acute viral bronchiolitis? A physiologic study.
Intensive Care Med
HFNC with a flow rate equal to or above 2 L/kg/min generated a clinically relevant PP, with improved breathing pattern and rapid unloading of respiratory muscles, in young infants with acute RSV bronchiolitis.
Reduced intubation rates for infants after introduction of high-flow nasal prong oxygen delivery.
Intensive Care Medicine
HFNP therapy has dramatically changed ventilatory practice in infants <24 months of age in our institution, and appears to reduce the need for intubation in infants with viral bronchiolitis.
High flow nasal cannulae therapy in infants with bronchiolitis.
J Paediatrics
We hypothesize that HFNC decreases rates of intubation in infants with bronchiolitis by decreasing the respiratory rate and work of breathing by providing a comfortable and well-tolerated means of noninvasive ventilatory support
Research in high flow therapy: mechanisms of action.
Respiratory Medicine
Explains mechanisms of action
Children with respiratory distress treated with high-flow nasal cannula.
J Intensive Care Med
High-flow nasal cannula improves the respiratory scale score, the oxygen saturation, and the patient's COMFORT scale. Its mechanism of action is application of mild positive airway pressure and lung volume recruitment.
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