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 Applications

nHFT. Nasal high flow therapy

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Application of heated and humidified breathing gas

Nasal high-flow therapy (nHFT) describes the supply of heated and humidified breathing gas via a nasal cannula. The gas flow administered is thus higher than the patient’s inspiratory respiratory flow. In neonatology, a flow of more than 1 LPM is considered to be high-flow therapy, while for adults, correspondingly higher values should be applied. (Roehr CC, Yoder BA, Davis PG, Ives K. Evidence Support and Guidelines for Using Heated, Humidified, High-Flow Nasal Cannulae in Neonatology: Oxford Nasal High-Flow Therapy Meeting, 2015. Clin Perinatol. 2016;43(4):693-705. doi:10.1016/j.clp.2016.07.0061​)

Other names for nHFT: High-Flow Nasal Cannula (HFNC) or Heated Humidified High-Flow Nasal Cannula. All of them designate the same form of therapy.

  • Easy and gentle application

  • Perfect complement to nCPAP respiratory support

  • Reduction in breathing effort

  • Available in the medinCNOmini, medin-NC3 and medinSINDI devices

Improved oxygen supply

If the breathing gas flows exceed the patient’s inspiratory flows, the supply of room air via the nose can be reduced or prevented, in contrast to the conventional low-flow nasal cannula therapy. As a result, the oxygenation and efficacy of the oxygen supply can be improved. (Roehr CC, Yoder BA, Davis PG, Ives K. Evidence Support and Guidelines for Using Heated, Humidified, High-Flow Nasal Cannulae in Neonatology: Oxford Nasal High-Flow Therapy Meeting, 2015. Clin Perinatol. 2016;43(4):693-705. doi:10.1016/j.clp.2016.07.0061​)

The anatomic dead space is washed out through the breathing gas flow and thus reduced, which in turn can lead to a decrease in breathing effort. The carbon dioxide remaining in the upper airway at the end of expiration can also be washed out by the high breathing gas flow. (Roehr CC, Yoder BA, Davis PG, Ives K. Evidence Support and Guidelines for Using Heated, Humidified, High-Flow Nasal Cannulae in Neonatology: Oxford Nasal High-Flow Therapy Meeting, 2015. Clin Perinatol. 2016;43(4):693-705. doi:10.1016/j.clp.2016.07.0061​, Saslow JG, Aghai ZH, Nakhla TA, et al. Work of breathing using high-flow nasal cannula in preterm infants. J Perinatol. 2006;26(8):476-480. doi:10.1038/sj.jp.72115302​)

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The application takes place in each case via our medinNuflow nasal cannulas and is thus very easy and gentle to the patient. To ensure the rinsing effect, the nasal cannula must be selected such that at least 50% of the nostril remains unobstructed, as intended leakage. The breathing gas flow can escape from the nose via this leakage.

No patient and tube pressures can be measured during nHFT. To protect the patient from undesired high pressures, it is necessary to maintain this leakage as a sort of overpressure valve. (Roehr CC, Yoder BA, Davis PG, Ives K. Evidence Support and Guidelines for Using Heated, Humidified, High-Flow Nasal Cannulae in Neonatology: Oxford Nasal High-Flow Therapy Meeting, 2015. Clin Perinatol. 2016;43(4):693-705. doi:10.1016/j.clp.2016.07.0061​)

Switch easily from the nCPAP modes to the nHFT mode

medin offers the nHFT application in the medinSINDI, medinCNOmini and medin-NC3 devices.

They can intuitively and easily switch from the nCPAP modes to the nHFT mode without the need to change the tubing system. The Medijet CPAP generator only needs to switch to the medin nasal cannula.

CPAP pauses, skin-to-skin care as well as treatment changes can be implemented easily and quickly. Your patients can receive flexible, individualized care as a result.

The following parameters are to be set

  • Flow: In L/min; 1-8 LPM as primary flow range for premature infants and newborns
  • 8-12 LPM to be selected as second flow range via push and turn function to avoid the unintentional administration of flow values over 8 LPM
  • Oxygen: From 21%-100%

References

  1. 1. Roehr CC, Yoder BA, Davis PG, Ives K. Evidence Support and Guidelines for Using Heated, Humidified, High-Flow Nasal Cannulae in Neonatology: Oxford Nasal High-Flow Therapy Meeting, 2015. Clin Perinatol. 2016;43(4):693-705. doi:10.1016/j.clp.2016.07.006

 

  1. 2. Saslow JG, Aghai ZH, Nakhla TA, et al. Work of breathing using high-flow nasal cannula in preterm infants. J Perinatol. 2006;26(8):476-480. doi:10.1038/sj.jp.7211530

Footnotes

 

Evidence Support and Guidelines for Using Heated, Humidified, High-Flow Nasal Cannulae in Neonatology: Oxford Nasal High-Flow Therapy Meeting, 2015.

Roehr CC, Yoder BA, Davis PG, Ives K. Evidence Support and Guidelines for Using Heated, Humidified, High-Flow Nasal Cannulae in Neonatology: Oxford Nasal High-Flow Therapy Meeting, 2015. Clin Perinatol. 2016;43(4):693-705. doi:10.1016/j.clp.2016.07.006

Nasal high-flow therapy (nHFT) has become a popular form of noninvasive respiratory support in neonatal intensive care units. A meeting held in Oxford, UK, in June 2015 examined the evidence base and proposed a consensus statement. In summary, nHFT is effective for support of preterm infants following extubation. There is growing evidence evaluating its use in the primary treatment of respiratory distress. Further study is needed to assess which clinical conditions are most amenable to nHFT support, the most effective flow rates, and escalation and weaning strategies. Its suitability as first-line treatment needs to be further evaluated.

Work of breathing using high-flow nasal cannula in preterm infants.

Saslow JG, Aghai ZH, Nakhla TA, et al. Work of breathing using high-flow nasal cannula in preterm infants. J Perinatol. 2006;26(8):476-480. doi:10.1038/sj.jp.7211530



OBJECTIVE

To compare the work of breathing (WOB) in premature neonates supported with high-flow nasal cannula (HFNC) and nasal continuous positive airway pressure (NCPAP).

STUDY DESIGN

Eighteen preterm neonates <2.0 kg on HFNC or NCPAP support were studied in a random order. A ventilator was used to deliver 6 cm H2O of NCPAP with nasal prongs. High-flow nasal cannula delivered with Vapotherm (VAPO) at 3, 4 and 5 l/min was used. Tidal ventilation was obtained using respiratory inductance plethysmography calibrated with face-mask pneumotachography. An esophageal balloon estimated pleural pressure from which changes in end distending pressure were calculated. Inspiratory, elastic and resistive WOB and respiratory parameters were calculated.

RESULTS

No differences were found in the WOB for all settings. Changes in end distending pressure did not vary significantly over all device settings except VAPO at 5 l/min.

CONCLUSION

In these preterm infants with mild respiratory illness, HFNC provided support comparable to NCPAP.