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G92(P) 4-year experience of using high flow nasal cannula (hfnc) oxygen therapy on paediatric wards

We describe our experience of using High Flow Nasal Cannula (HFNC) Oxygen on the paediatric wards during a 4 year period from January 2014 to October 2017. A standard operating procedure (SOP) provided instructions and guidance for the use of HFNC. Retrospective analysis of demographic data,clinical conditions, indications, HFNC settings, adherence to SOP, adverse events and safety profile was undertaken over the 4 year period. HFNC was used in 124 babies and children, for a variety of conditions requiring respiratory assistance. Bronchiolitis was the commonest indication for the use of HFNC, followed by pneumonia, viral induced wheeze, asthma, and for alleviation of respiratory distress at the end of life in palliative care situations. Relatively high flow rates compared to other centres of upto 4 Litres/kg was used, with no adverse effects such as air leaks. Conversion to NIV modalities such as CPAP and BiPap and intubation rates was comparable to other centres. Our findings agreed with previous studies that HFNC failure rates could be predicted by the lack of repsonse of respiratory distress and oxygen requirement, 60–90 min after commenicng HFNC. Incremental expansion of the use of HFNC was seen over the study period as well as extension of its use to a variety of clinical conditions. This was achieved without additional medical resources, but by nursing empowerment through training for the safe initiation, weaning and cessation of HFNC, as well as timely escalation. Our experience of the use of HFNC is unique in using high flow rates in large numbers of children with a wide variety of respiratory conditions, in a non-paediatric intensive care setting.