Published online June 2, 2008
PEDIATRICS Vol. 121 No. 6 June 2008, pp. 1294 (doi:10.1542/peds.2008-0901)

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LETTER TO THE EDITOR

Heated, Humidified High-Flow Nasal Cannula Therapy: In Reply

Zuzanna Kubicka, MD
Division of Newborn Medicine
Children's Hospital Boston
Boston, MA 02115

Robert Darnall, MD
Departments of Pediatrics and Physiology

Joseph Limauro, RRT
Department of Respiratory Therapy
Dartmouth Medical School and Dartmouth-Hitchcock Medical Center
Lebanon, NH 03756

We welcome the interest shown by Weiner et al in our article on the use of high-flow nasal cannulas in the neonatal population. However, we would like to address a few important issues. The authors report the pharyngeal pressures achieved by using Vapotherm with 2-mm outer-diameter prongs in only 2 large infants. They describe passing a 2F catheter transnasally to measure pharyngeal pressure, which possibly could have altered the size of the nasal leak. We also emphasized that for infants who weighed >1500 g, we found no relationship between the flow rate and maximal oral cavity pressure, which we attributed to the presence of a larger nasal leak. Oral cavity pressure generated by high-flow nasal cannula ultimately depends on whether the mouth is closed, the flow rate, and the size of the nasal leak. Clinically relevant levels of continuous positive airway pressure could be achieved only in infants <1500 g with higher flow rates and their mouths fully closed. The most important issues addressed by our study were safety and monitoring. Clinicians who use high-flow nasal cannula therapy should be aware of the possibility of generating high pressures in the smallest infants when using higher flow rates with the infants' mouths fully closed and when the nasal leak is minimized or eliminated by using larger nasal prongs.

REFERENCE

1. Kubicka Z, Limauro J, Darnall R. Heated, humidified high-flow nasal cannula therapy: yet another way to deliver continuous positive airway pressure? Pediatrics. 2008;121 (1):82 –88[Abstract/Free Full Text]

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PEDIATRICS (ISSN 1098-4275). ©2008 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Kubicka, Z. Articles by Limauro, J. Search for Related Content PubMed PubMed Citation Articles by Kubicka, Z. Articles by Limauro, J. Related Collections Respiratory Tract Social Bookmarking                         What's this?