High-Flow Nasal Cannula and Noninvasive Ventilation in Pediatric Emergency Medicine | Digest
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High-Flow Nasal Cannula and Noninvasive Ventilation in Pediatric Emergency Medicine

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Points & Pearls Excerpt

  • Respiratory failure is the leading cause for admission to the pediatric intensive care unit. Noninvasive ventilation (NIV) can be used for pediatric respiratory failure to delay or prevent endotracheal intubation and its subsequent complications.
  • High-flow nasal cannula (HFNC) improves gas exchange and breathing efficiency in pediatric patients with respiratory distress. HFNC is an open system that provides humidified air at higher flow rates than nasal cannula, with some degree of positive end-expiratory pressure (PEEP) (3-6 cm H2O). Flow rates between 1.5 to 2 L/kg/min are recommended and can be titrated to the desired clinical effect.
  • NIV with continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BPAP) provides positive pressure ventilation and increases lung compliance. Patient intolerance and inappro-priate mask fit may lead to treatment failure.
  • CPAP delivers a continuous level of pressure to the airways. It is recommended to start at a pressure of 3 cm H2O and titrate up to a maximum of 10 cm H2O. Bubble CPAP with nasal prongs is used in older infants to stent airways open and improve gas exchange.
  • BPAP provides higher inspiratory pressures and therefore is generally preferred over CPAP for hypercapnic respiratory failure. BPAP also creates higher mean airway pressures, and it is therefore also effective for hypoxemic respiratory failure if CPAP fails.

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Publication Information

Daniel Slubowski, MD; Timothy Ruttan, MD, FACEP

Peer Reviewed By

Deborah A. Levine, MD; Joshua Nagler, MD, MHPEd

Publication Date

August 2, 2020

CME Expiration Date

August 3, 2023

CME Credits

4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits.

Pub Med ID: 32678565

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CME Information

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