![]() Studies in preterm infants 30, 32, 35, 36 indicate that, in comparison with CPAP, synchronized NIPPV decreased the work of breathing, improved thoracoabdominal asynchrony, increased tidal volumes and minute ventilation, and decreased carbon dioxide concentrations. 34 The physiologic benefits of NIPPV may depend on whether the breaths are synchronized or nonsynchronized. Data from surfactant-deficient piglets indicate that NIPPV results in less lung inflammation than synchronized intermittent mandatory ventilation. In addition, NIPPV may trigger an augmented inspiratory reflex (Head’s paradoxical reflex) in preterm infants. NIPPV offers the main physiologic advantage of CPAP (ie, stabilization of alveoli by positive airway pressure) and theoretically promotes better ventilation by delivering positive pressure breaths to the lower airways. CPAP has also been used to treat apnea of prematurity and is considered an evidence-based strategy to decrease postextubation failure. 4, 5 The most immature infants (24–25 weeks’ gestational age) may benefit most from this strategy, 6 even though all randomized trials to date have shown a high rate of CPAP failure in these infants. More recent randomized clinical trials have demonstrated that, in comparison with prophylactic or early use of surfactant, the use of CPAP decreases the need for invasive mechanical ventilation and the combined outcome of death or BPD. 2 In 1987, Avery et al 3 published a small observational study suggesting that using continuous positive airway pressure (CPAP) as the primary mode of respiratory support reduced the need for supplemental oxygen at 28 days of life. 1 Attempts to decrease lung injury by using gentler ventilation strategies and restricting oxygen use have resulted in only modest improvements in the incidence of BPD. All rights reserved.Mechanical ventilation increases survival in preterm infants with respiratory failure however, it is associated with an increased risk of bronchopulmonary dysplasia (BPD) and adverse neurodevelopmental outcomes. other respiratory support modalities.īronchiolitis Bronquiolite Children Crianças Cânula nasal de alto fluxo Departamento de emergência Emergency department High-flow nasal cannula.Ĭopyright © 2017 Sociedade Brasileira de Pediatria. High-flow nasal cannula should be considered for pediatric emergency department patients with respiratory distress not requiring immediate endotracheal intubation prospective, pediatric emergency department-specific trials are needed to better determine responsive patient populations, ideal high-flow nasal cannula settings, and comparative efficacy vs. Patient characteristics, such as improved tachycardia and tachypnea, have been associated with a lack of progression to endotracheal intubation. ![]() Limited prospective interventional data suggest that high-flow nasal cannula may be similarly efficacious as continuous positive airway pressure and more efficacious than standard oxygen therapy for some patients. Introduction of high-flow nasal cannula into clinical practice, including in the emergency department, has been associated with decreased rates of endotracheal intubation. Most data describing high-flow nasal cannula use in children focuses on those with bronchiolitis, although high-flow nasal cannula has been used in children with other respiratory diseases. High-flow nasal cannula likely supports respiration though reduced inspiratory resistance, washout of the nasopharyngeal dead space, reduced metabolic work related to gas conditioning, improved airway conductance and mucociliary clearance, and provision of low levels of positive airway pressure. High-flow nasal cannula, a non-invasive respiratory support modality, provides heated and fully humidified gas mixtures to patients via a nasal cannula interface. To summarize the current literature describing high-flow nasal cannula use in children, the components and mechanisms of action of a high-flow nasal cannula system, the appropriate clinical applications, and its role in the pediatric emergency department.Ī computer-based search of PubMed/MEDLINE and Google Scholar for literature on high-flow nasal cannula use in children was performed.
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