The use of high flow nasal cannulae in neonatal intensive care units: Is clinical practice consistent with the evidence?

Abstract

Background: In the recent years, a new treatment modality, high-flow nasal cannulae (HFNC) has become widely used despite limited systematic evaluation.

Objective: To survey the attitudes and practices in academic neonatal units in the United States regarding the use of HFNC and to review the current literature on HFNC.

Methods: A questionnaire regarding HFNC use was distributed to all (n=97) Neonatal-Perinatal Medicine Fellowship Training Program Directors in the United States.

Results: Fifty eight (60%) program directors responded to the questionnaire. Of these 40 (69%) reported using heated humidified HFNC (HHHFNC) and 18 (31%) not using this modality. Reported starting flows ranged from 1 to 6 L/min and maximal flows from 2 to 8 L/min. The indication for use of HHHFNC varied between units.

Conclusions: The findings of our survey and our review of the literature suggest that the use of HHHFNC is widespread despite lack of evidence of efficacy from large clinical trials. The indications for HHHFNC and the initial, minimal and maximal flows varied widely among the centers. This report supports the need for well designed randomized controlled clinical trials to evaluate the efficacy and safety of HHHFNC for a variety of clinical indications.