CCCF ePoster library. Giraldo Salazar J. Oct 31, 2016; 150890; 18 Disclosure(s): Grant: McMaster Resident Research Award
Juliana Giraldo Salazar
Juliana Giraldo Salazar
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Topic: Retrospective or Prospective Cohort Study


Giraldo, Juliana1; Alshueili,Hamood1; Cheng,Ji2; Thabane, Lehana2; Monkman, Shelley3; Nykolaychuk, Allison1; Choong, Karen1
Deparment of Pediatrics, McMaster University, Hamilton, Canada; 2Department of Clinical epidemiology and Biostatistics, McMaster University, Hamilton, Canada; 3Department of Neonatology, McMaster University, Hamilton, Canada

Grant acknowledgements:
This study was funded by the Department of Paediatrics at McMaster University


Introduction: Humidified High Flow Nasal cannula therapy (HHFNC) is an increasingly common mode of respiratory support in pediatrics. While proposed to generate positive airway pressure, the amount of airway pressure delivered by newer HHFNC devices has not been adequately evaluated. The objectives of this study were to 1) measure the airway pressure delivered, and 2) evaluate the variables that may influence the delivery of positive airway pressure, during HHFNC.

Methods: Prospective observational cohort study at McMaster Children`s Hospital, Pediatric Critical Care Unit (PCCU), Canada. Children under 18 years on HHFNC support (Optiflow JrTM) were eligible. Esophageal pressure (Pes) was measured as a surrogate for airway pressure, using a previously validated method. The primary outcome was the relationship between delivered flow rates on HHFNC, and Pes (analysed using analysis of variance). Secondary endpoints included predictors of Pes during HHFNC. We hypothesized that patient size, disease severity and work of breathing may influence Pes, and planned to  analyze these potential predictors using regression methods.

Preliminary Results: Thirty-four Pes measurements have been conducted in a total of 12 patients to date. Patients ranged from 12 days of age to 13 years, the median weight was 5.88 kg (3.2 - 89 Kg), and 9 (75%) were males. The commonest diagnoses necessitating HHFNC in these patients were pneumonia and bronchiolitis. HHFNC flow rates ranged from minimum of 5 to maximum of 25L/min. HHFNC generated median Pes of 5.5 (range 2 – 11.5) in infants, and 8 (5-11) cm H2O in children. While there was a moderate positive linear correlation between HHFNC flow rate and Pes (Pearson correlation coefficient of 0.486), we observed a ceiling effect with HHFNC. Regression analyses are underway to evaluate predictors that may affect Pes generated by HHFNC in this population.

Conclusion: HHFNC generates measurable airway end-distending pressure, which correlates moderately with delivered flow rates, but only to a maximum of 11.5 cm H2O. Different patient characteristics may play a role in the amount of airway pressure generated.

Key words: HHFNC, high flow, airway pressure, esophageal pressure, children.

  1. Randolph AG, Meert KL, O'Neil ME et al. (2003). The feasibility of conducting clinical trials in infants and children with acute respiratory failure. Am. J. Respir. Crit. Care Med. 167(10), 1334–1340.
  2. Yanez LJ, Yunge M, Emilfork M, et al. A prospective, randomized, controlled trial of noninvasive ventilation in pediatric acute respiratory failure. Pediatr Crit Care Med 2008; 9:484–489.
  3. Dysart, K., et al. (2009). Research in high flow therapy: mechanisms of action. Respir Med 103(10): 1400-1405.
  4. Deis, J. (2008). Noninvasive respiratory support. Pediatric Emergency Care, 24(5), 331-338.
  5. Ward, J. J. (2013). High-flow oxygen administration by nasal cannula for adult and perinatal patients. Respir Care 58(1): 98-122.
  6. Sreenan, C., et al. (2001). High-flow nasal cannulae in the management of apnea of prematurity: a comparison with conventional nasal continuous positive airway pressure. Pediatrics 107(5): 1081-1083.
  7. Saslow, J. G., et al. (2006). Work of breathing using high-flow nasal cannula in preterm infants. J Perinatol 26(8): 476-480.
  8. Kubicka, Z. J., et al. (2008). Heated, humidified high-flow nasal cannula therapy: yet another way to deliver continuous positive airway pressure? Pediatrics 121(1): 82-88.
  9. Spence, K. L., et al. (2007). High-flow nasal cannula as a device to provide continuous positive airway pressure in infants. J Perinatol 27(12): 772-775.
  10. Lampland, A. L., et al. (2009). Observational study of humidified high-flow nasal cannula compared with nasal continuous positive airway pressure. J Pediatr 154(2): 177-182.
  11. Milesi, C., et al. L(2013). Is treatment with a high flow nasal cannula effective in acute viral bronchiolitis? A physiologic study.  Intensive Care Med 39(6): 1088-1094.
  12. Arora, B., et al. (2012). Nasopharyngeal airway pressures in bronchiolitis patients treated with high-flow nasal cannula oxygen therapy. Pediatr Emerg Care 28(11): 1179
  13.  Wilkinson, D. J., et al. (2008). Pharyngeal pressure with high-flow nasal cannulae in premature infants. J Perinatol 28(1): 42-47.
  14.  Rubin, S., et al. (2014). 'Effort of breathing in children receiving high-flow nasal cannula.' Pediatr Crit Care Med 15(1): 1-6.
  15. Wald, M., et al. (2011). 'Variety of expiratory resistance between different continuous positive airway pressure devices for preterm infants.' Artif Organs 35(1): 22-28.
  16. Pollack, Murray M., et al. (1996). PRISM III: An updated Pediatric Risk of Mortality score. Critical Care Medicine. 24(5):743-752.
  17. Leteurtre S, Duhamel A, Salleron J, Grandbastien B, Lacroix J, Leclerc F, et al. PELOD-2: An Update of the PEdiatric Logistic Organ Dysfunction Score. Crit Care Med. 2013;41(7):1761-73.
  18. Bernard GR, Artigas A, Brigham KL, et al. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994;149(3 Pt 1):818–824.
  19. McCallum, G. B., et al. (2013). 'Severity scoring systems: are they internally valid, reliable and predictive of oxygen use in children with acute bronchiolitis?' Pediatr Pulmonol 48(8): 797-803.
  20. Akoumianaki, E., et al. (2014). 'The application of esophageal pressure measurement in patients with respiratory failure.' Am J Respir Crit Care Med 189(5): 520-531.
  21. Hough, J. L., et al. (2014). 'Physiologic effect of high-flow nasal cannula in infants with bronchiolitis.' Pediatr Crit Care Med 15(5): e214-219. Hough, J. L., et al. (2014).
  22. Al-Alaiyan, S., et al. (2014). 'Positive distending pressure produced by heated, humidified high flow nasal cannula as compared to nasal continuous positive airway pressure in premature infants.' J Neonatal Perinatal Med 7(2): 119-124.
  23. Asher MI, Coates AL, Collinge JM, Milic-Emili J. Measurement of pleural pressure in neonates. J Appl Physiol 1982.
  24. Frey U, Stocks J, Coates A, et al: Specifications for equipment used for infant pulmonary function testing. ERS/ATS Task Force on Standards for Infant Respiratory Function Testing. European Respiratory Society/American Thoracic Society. Eur Respir J 2000; 16: 731–740.


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