Published online July 1, 2008
PEDIATRICS Vol. 122 No. 1 July 2008, pp. 219 (doi:10.1542/peds.2008-1185)

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LETTER TO THE EDITOR

Heated, Humidified High-Flow Nasal Cannula Therapy: Yet Another Way to Deliver Continuous Positive Airway Pressure?: In Reply

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

We thank BouAram and Fernandes for their letter regarding our observational study¹ on the effect of high-flow nasal cannula use in a neonatal population. We would like to address some of the issues they raised.

We submit that measuring oral cavity pressure is an easy way to estimate the "level" of continuous positive airway pressure (CPAP) administered under clinical situations, which in our unit is usually between 4 and 6 cmH₂O. We made measurements in enough infants of different weights and ages to convince ourselves that these measurements, when made under the conditions of our study (ie, mouth closed), approximated the pressure measured in the CPAP device. Although we do not advocate the use of heated high-flow nasal cannula therapy as a replacement for standard techniques of delivering nasal CPAP, measuring oral cavity pressure is an easy way to confirm that some level of CPAP is or is not being provided.¹

It was not our intent to study the popularity of high-flow nasal cannula therapy, the frequency of its use in comparison to nasal CPAP, or whether it has changed over time. We do believe that this approach, even when using low flow rates, has advantages over the use of standard nasal cannula therapy for the delivery of oxygen, because it provides gas that is heated and humidified.^2–4 Indeed, it is not clear to us why many continue to provide unheated and only partially humidified gas through nasal cannulas to small infants. We caution, however, that the use of high flow rates, especially in the smallest infants with tight-fitting nasal prongs, could lead to unanticipated and possibly dangerously high pressures.¹

Finally, it was our hope that our simple "physiological" study would stimulate interest in a larger randomized study, as BouAram and Fernandes suggest. We strongly agree that future randomized studies are needed to address the usefulness of this oxygen-delivery method in treating apnea of prematurity or as substitute for conventional CPAP in a larger neonatal population.

REFERENCES

1. Kubicka ZJ, Limauro J, Darnall RA. 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]
2. Kopelman AE, Holbert D. Use of oxygen cannulas in extremely low birthweight infants is associated with mucosal trauma and bleeding, and possibly with coagulase-negative staphylococcal sepsis. J Perinatol.2003; 23 (2):94 –97[CrossRef][Medline]
3. Schulze A. Respiratory gas conditioning in infants with an artificial airway. Semin Neonatol.2002; 7 (5):369 –377[CrossRef][Medline]
4. Tarnow-Mordi WO, Reid E, Griffiths P, Wilkinson AR. Low inspired gas temperature and respiratory complications in very low birth weight infants. J Pediatr.1989; 114 (3):438 –442[CrossRef][Web of Science][Medline]

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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 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. Search for Related Content PubMed Articles by Kubicka, Z. Related Collections Premature & Newborn Social Bookmarking                         What's this?