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High Flow Oxygen Therapy

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High Flow Oxygen Therapy

High flow oxygen therapy is a treatment option for an acute respiratory syndrome that

provides breathing support and has been popularly used in pediatric care for infants and children

(Clayton et al., 2021; Kwon, 2020). This literature review considers HFNC studies focusing on

infants as related to the case of baby M, who has been diagnosed with acute respiratory distress

syndrome (ARDS). Sepsis is the likely cause of the baby’s condition and is one of the major

infectious diseases that is a predisposing factor for ARDS (Swenson & Swenson, 2021). The

high-flow nasal cannula oxygen (HFNC) therapy was considered effective to help the infant to

reduce its breathing effort and to create small amounts of positive pressure in the upper airway,

improving oxygen delivery.

Maternal and Neonatal Histories

Intervention

Why the Intervention is Necessary and Aims of the Treatment

HFNC is recommended for infants who continue to have low oxygen levels as it has been

evidenced to be applicable in pediatric intensive units to help improve the work of breathing for

the infants and to reduce airway resistance for them (Clayton et al., 2021). It supports breathing

for infants and children with various conditions including acute respiratory distress syndrome

(ARDS). With this case study involving a case of ARDS in a baby, high flow oxygen therapy is

considered a necessary treatment option. The treatment will help reduce the effort that the baby’s

body needs to put into breathing as well as create some positive pressure in the upper airways to

improve oxygen delivery (Chauvin-Kimoff & DeCaen, 2018). Compared to traditional therapy,
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delivered through safe masks, the high flow oxygen therapy provides a better clearance of fluids

or secretions due to humidified air. It is also better tolerated, is more comfortable, and it makes it

easier to eat and drink during therapy. Also, it offers less dryness of the mouth and reduced

inflammation of the airway.

Link to Relevant Pathophysiology

The pathophysiology of ARDS is marked by disruptions in the alveolar-capillary

disruptions due to inflammation, reduced alveolar collapse, formation of edema, reduced

compliance, and increased pulmonary vascular resistance, as well as the resulting gas exchange

abnormalities (Swenson & Swenson, 2021). Defects in the ventilation or perfusion, including

shunt and dead space, are responsible for the gaseous exchange impairments in ARDS. This can

be associated with various infectious causes and non-infectious injuries including sepsis and

pneumonia, which are infections that are among the leading predisposing factors for ARDS.

Mechanical ventilation may further complicate the inflammation of the lung and injury in ARD

especially if it is delivered using high pressures and/or tidal volumes. The resolution of ARDS is

a complex issue that requires coordination in activating multiple resolution pathways including

the repair of alveolar epithelial, clearing pulmonary edema through an active ion transport,

clearing the ultra-alveolar neutrophils, apoptosis, and resolution of inflammation.

The resolution chosen for this case is high flow oxygen, which is linked to the condition’s

pathophysiology through resolutions. By setting a higher oxygen flow than the inspiratory

demand flow, the intervention can result in the washout of the upper airways, reduced nasal

resistances, as well as decreased dead space (Kwon, 2020). Heated humidification in high-flow

oxygen therapy enables the clearance of secretions and a reduction of bronchoconstriction. This

contributes to the reduction of inflammation, which is an aspect of the pathophysiology of

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ARDS, implying a link between the high flow oxygen therapy and the condition’s

pathophysiology.

Literature Review

Summary

High flow oxygen therapy is a form of non-invasive therapy, which means that it does not

require the breaking of the skin. This intervention is appropriate for infants and children

experiencing respiratory distress with the flow rates delivering oxygen at higher concentrations

of oxygen (Chauvin-Kimoff & DeCaen, 2018). High-flow nasal cannula (HFNC) therapy is

preferred, having been accepted as a treatment option that is suitable for acute respiratory

support before invasive ventilation. Studies find that HFNC is widely used across the world,

especially in pediatric intensive care units (Clayton et al., 2021). According to Kadafi et al.

(2022), HFNC is tolerated more in infants and children’s acute respiratory diseases as it is

associated with less nasal injury, lower heart rate inflicted, and improved comfort index score.

When HFNC is compared to conventional therapy, it is safer in a variety of conditions including

asthma, pneumonia, and bronchiolitis among others.

In preterm infants, HFNC therapy prevents reintubation as well as the initial noninvasive

respiratory support following birth (Kwon, 2020). In children, adjustment of the flow levels is

essential as it is highly efficacious. Observational studies have demonstrated that HFNC therapy

is beneficial to such respiratory distress cases as the one involved in this case study (Kwon,

2020). It not only improves the fraction of inspired oxygen (FiO2), but it also helps reduce and

wash dead space to reduce the work of breathing, provide more comfort than cold and dry

oxygen, and generate positive end-expiratory pressure (PEEP).

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Statement of Findings

The literature review finds have demonstrated that HFNC is an effective treatment option

for infant and children with acute respiratory distress. It has also been found to be beneficial in

other conditions including asthma, pneumonia, bronchiolitis, and respiratory distress syndromes

among others. The use of HFNC in infants and children’s acute respiratory conditions helps to

lower heart rate, improve the complex index score, and ensure less nasal mucosal injury (Kadafi

et al., 2022). However, Kadafi et al. (2022) note that the use of this therapy should be determined

based on such factors as body weight, the severity of the distress, and the causation of the

disease. These are some of the considerations made when recommending the HFNC intervention

for baby M.

Studies also show that the use of pediatric intensive care units was initially studied as an

alternative for non-invasive ventilation (Clayton et al., 2021). However, studies have consistently

demonstrated its therapeutic benefits concerning the patient’s vital signs and clinical measures of

their breathing effort. The benefits of HFNC range from better clearance of fluids aided by the

humidified air, less dryness of the mouth as well as reduced inflammation of the airways

(Chauvin-Kimoff & DeCaen, 2018). Also, HFNC is better tolerated and more comfortable, it

makes it easier to communicate during therapy, and it also makes it easier to eat and drink during

therapy. Generally, HFNC is associated with very few risks as it is a non-invasive ventilation

method that does not require the breaking of the skin.

HFNC has enabled the successful treatment of many infants and children with ARDS

with mortality and without the need for invasive ventilatory support (Panadero et al., 2020).

These outcomes together with the effectiveness of HFNC in avoiding intubation and the

associated complications, make this form of therapy the first treatment method for ARDS. HFNC
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is also safe and is perceived as reasonable for optimizing the available resources, avoiding

admissions into the intensive care units, or ensuring that such admissions are only limited to the

most severely ill patients (Clayton et al., 2021; Panadero et al., 2020).

HFNC does not only reduce intubation but also mechanical ventilation in infants

experiencing mechanical failure. Kwon (2020) suggests that it decreases the rate of intubation

and the number of mechanical ventilator days per admission. However, while studies have

provided extensive evidence on the benefits associated with HFNC, it should be carefully

monitored to identify potential complications and the non-responders (Kwon, 2020).

Recommendations indicate that the use of this modality depends on the specific cause of

respiratory distress (Kadafi et al., 2021). Some studies suggest wide variability in practice

depending on the disease indication, flow settings, and the lack of studies to assess indications

for initiating, escalating, and weaning the HFNC therapy (Clayton et al., 2021).

Conclusion

High flow nasal cannula therapy is a non-invasive treatment option that is considered

effective and safe in the treatment of various conditions including acute respiratory syndrome

(ARDS). This intervention has broadly been used across the world especially in pediatric

intensive care units as it has a variety of potential benefits. As a method that is more tolerated in

the treatment of ARDS in children, we recommended its application in the treatment of baby M.

Its application, in this case, is expected to help decrease the child’s breathing effort and improve

oxygen delivery by creating small amounts of positive pressure in the upper airways.
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References

Chauvin-Kimoff, L., & DeCaen, A. (2018). Use of high-flow nasal cannula oxygen therapy in

infants and children. Paediatrics & Child Health, 23(8), 555-555.

https://doi.org/10.1093/pch/pxy142

Clayton, J. A., Slain, K. N., Shein, S. L., & Cheifetz, I. M. (2022). High flow nasal cannula in the

pediatric intensive care unit. Expert Review of Respiratory Medicine, 16(4), 409-417.

https://doi.org/10.1080/17476348.2022.2049761

Kadafi, K. T., Yuliarto, S., Monica, C., & Susanto, W. P. (2021). Clinical review of High Flow

Nasal Cannula and Continuous Positive Airway Pressure in pediatric acute respiratory

distress. Annals of Medicine and Surgery, 103180.

https://doi.org/10.1016/j.amsu.2021.103180

Kwon J. W. (2020). High-flow nasal cannula oxygen therapy in children: a clinical

review. Clinical and Experimental Paediatrics, 63(1), 3–7.

https://doi.org/10.3345/kjp.2019.00626

Swenson, K. E., & Swenson, E. R. (2021). Pathophysiology of Acute Respiratory Distress

Syndrome and COVID-19 Lung Injury. Critical care clinics, 37(4), 749–776.

https://doi.org/10.1016/j.ccc.2021.05.003

Panadero, C., Abad-Fernández, A., Rio-Ramirez, M. T., Acosta Gutierrez, C. M., Calderon-

Alcala, M., Lopez-Riolobos, C., Matesanz-Lopez, C., Garcia-Prieto, F., Diaz-Garcia, J.

M., Raboso-Moreno, B., Vasquez-Gambasica, Z., Andres-Ruzafa, P., Garcia-Satue, J. L.,

Calero-Pardo, S., Sagastizabal, B., Bautista, D., Campos, A., González, M., Grande, L.,

Fernandez, J. M., … & Alcaraz, A. J. (2020). High-flow nasal cannula for acute
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respiratory distress syndrome (ARDS) due to COVID-19. Multidisciplinary respiratory

medicine, 15(1), 693. https://doi.org/10.4081/mrm.2020.693