EC Paediatrics

Review Article Volume 14 Issue 1 - 2025

High-Flow Nasal Cannula Oxygen Therapy in Infants and Children Versus Other Non-Invasive Ventilation: A Review of Current Knowledge

Mariam Mahmoud Hassan Mahmoud Elmakkawy1*, Zurina Binti Zainudin1, Safwat Hassan Gad2, Melissa Anne Nunis1, Mohd Fahmi Bin Ellias1 and Khairoon Nisa Mohamed Nashrudin1

1Department of Paediatrics, Faculty of Medicine and Health Sciences, University Putra Malaysia, Selangor, Malaysia
2Department of Paediatrics, Faculty of Medicine, Asian Institute of Medicine, Science and Technology (AIMST University), Kedah, Malaysia

*Corresponding Author: Mariam Mahmoud Hassan Mahmoud Elmakkawy, Department of Paediatrics, Faculty of Medicine and Health Sciences, University Putra Malaysia, Selangor, Malaysia.
Received: December 23, 2024; Published: December 30, 2024



Respiratory distress is the leading cause of hospitalisation in paediatric intensive care units. Non-invasive ventilation can be delivered via continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP) or high-flow nasal cannula (HFNC). HFNC protocols are based only on manufacturers’ studies, with positive nasopharyngeal pressure as the primary endpoint. These protocols recommend the use of humidified air to prevent irritation of the airway mucosa. HFNC therapy may be better tolerated than traditional modes of non-invasive support, such CPAP and BiPAP in part owing to its smaller nasal prong interface allowing activities like breastfeeding with greater ease.

 Keywords: Paediatric Intensive Care; Continuous Positive Airway Pressure; High-Flow Nasal Cannula; Non-Invasive Ventilation; Preterm Infants

  1. RK Wiser., et al. “A pediatric high-flow nasal cannula protocol standardizes initial flow and expedites weaning”. Pediatric Pulmonology 5 (2021): 1189-1197.
  2. D Slubowski and T Ruttan. “High-flow nasal cannula and noninvasive ventilation in pediatric emergency medicine”. Pediatric Emergency Medicine Practice 8 (2020): 1-24.
  3. KN Slain., et al. “The use of high-flow nasal cannula in the pediatric emergency department”. Journal of Pediatrics 1 (2017): 36-45.
  4. EC Alexander., et al. “Effectiveness of high flow nasal Cannula (HFNC) therapy compared to standard oxygen therapy (SOT) and continuous positive airway pressure (CPAP) in bronchiolitis”. Paediatric Respiratory Reviews 52 (2024): 3-8.
  5. Dadlez NM., et al. “Safety of high-flow nasal cannula outside the ICU for previously healthy children with bronchiolitis”. Respiratory Care 11 (2019): 1410-1415.
  6. Milési C., et al. “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 (TRAMONTANE study)”. Intensive Care Medicine 2 (2017): 209-216.
  7. Milési C., et al. “High-flow nasal cannula: Recommendations for daily practice in pediatrics”. Annals of Intensive Care 4 (2014): 29.
  8. Parke RL., et al. “Effect of very-high-flow nasal therapy on airway pressure and end-expiratory lung impedance in healthy volunteers”. Respiratory Care 10 (2015): 1397-1403.
  9. Sweet DG., et al. “European consensus guidelines on the management of neonatal respiratory distress syndrome in preterm infants - 2013 update”. Neonatology4 (2013): 353-368.
  10. Ward JJ. “High-flow oxygen administration by nasal cannula for adult and perinatal patients”. Respiratory Care 1 (2012): 98-122.
  11. Mauri T., et al. “Physiologic effects of high-flow nasal cannula in acute hypoxemic respiratory failure”. American Journal of Respiratory and Critical Care Medicine 9 (2017): 1207-1215.
  12. Sivieri EM., et al. “Effect of HFNC flow rate, cannula size, and nares diameter on generated airway pressures: an in vitro study”. Pediatric Pulmonology 5 (2013): 506-514.
  13. Kepreotes E., et al. “High-flow warm humidified oxygen versus standard low-flow nasal cannula oxygen for moderate bronchiolitis (HFWHO RCT): an open, phase 4, randomised controlled trial”. Lancet10072 (2017): 930-939.
  14. Franklin D., et al. “A randomized trial of high-flow oxygen therapy in infants with bronchiolitis”. New England Journal of Medicine12 (2018): 1121-1131.
  15. Milesi C., et al. “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 (TRAMONTANE 2)”. Intensive Care Medicine 12 (2018): 1870-1878.
  16. Kline J., et al. “High flow nasal cannula therapy for bronchiolitis across the emergency department and acute care floor”. Clinical Pediatric Emergency Medicine 1 (2018): 40-45.
  17. Coon ER., et al. “Intensive care unit utilization after adoption of a ward-based high-flow nasal cannula protocol”. Journal of Hospital Medicine 6 (2020): 325-330.
  18. Durand P., et al. “A randomised trial of high-flow nasal cannula in infants with moderate bronchiolitis”. European Respiratory Journal 1 (2020): 1901926.
  19. Kalburgi S and Halley T. “High-flow nasal cannula use outside of the ICU setting”. Pediatrics5 (2020): e20194083.
  20. Armarego M., et al. “High-flow nasal cannula therapy for infants with bronchiolitis”. Cochrane Database of Systematic Reviews3 (2024): CD009609.
  21. Lin J., et al. “High-flow nasal cannula therapy for children with bronchiolitis: A systematic review and meta-analysis”. Archives of Disease in Childhood6 (2019): 564-576.
  22. Wilkinson D., et al. “High flow nasal cannula for respiratory support in preterm infants”. Cochrane Database of Systematic Reviews (2016): CD006405.
  23. Sand L., et al. “Observational cohort study of changing trends in non-invasive ventilation in very preterm infants and associations with clinical outcomes”. Archives of Disease in Childhood: Fetal and Neonatal Edition 2 (2022): 150-155.
  24. Taha DK., et al. “High flow nasal cannula use is associated with increased morbidity and length of hospitalization in extremely low birth weight infants”. Journal of Pediatrics 173 (2016): 50-55.
  25. Heath Jeffery RC., et al. “Increased use of heated humidified high flow nasal cannula is associated with longer oxygen requirements: high flow nasal cannula and longer oxygen requirements”. Journal of Paediatrics and Child Health 12 (2017): 1215-1219.
  26. Saengsin K., et al. “Predictive factors of extubation failure in pediatric cardiac intensive care unit: A single-center retrospective study from Thailand”. Frontiers in Pediatrics 11 (2023): 1156263.
  27. Wing R., et al. “Use of high-flow nasal cannula support in the emergency department reduces the need for intubation in pediatric acute respiratory insufficiency”. Pediatric Emergency Care 11 (2012): 1117-1123.
  28. Ramnarayan P., et al. “Effect of high-flow nasal cannula therapy vs continuous positive airway pressure following extubation on liberation from respiratory support in critically ill children: A randomized clinical trial”. Journal of the American Medical Association16 (2022): 1555-1565.
  29. Silva-Cruz AL., et al. “Risk factors for extubation failure in the intensive care unit”. Revista Brasileira de Terapia Intensiva 3 (2018): 294-300.

Mariam Mahmoud Hassan Mahmoud Elmakkawy., et al. "High-Flow Nasal Cannula Oxygen Therapy in Infants and Children Versus Other Non-Invasive Ventilation: A Review of Current Knowledge". EC Paediatrics 14.1 (2025): 01-05.