Conference abstract

High flow nasal cannula: a future device for resource-limited pediatric settings?

Pan African Medical Journal - Conference Proceedings. 2018:9(12).12 Aug 2018.
doi: 10.11604/pamj-cp.2018.9.12.739
Archived on: 12 Aug 2018
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Keywords: High Flow Nasal Cannula, HFNC, resource limited paediatric settings, humanitarian paediatrics

High flow nasal cannula: a future device for resource-limited pediatric settings?

Rebecca Anderson de la Llana1,&, Daniel Martinez Garcia2

1Pediatric Intensive Care Unit and Neonatology, University Hospital, Geneva, Switzerland, 2Médecins Sans Frontières, OCG, Geneva, Switzerland

&Corresponding author
Rebecca Anderson de la Llana, Pediatric Intensive Care Unit and Neonatology, University Hospital, Geneva, Switzerland


Introduction: global infant mortality has decreased dramatically with implementation of basic guidelines, scaling up of water and sanitation, strengthening of vaccination, and early detection and treatment of infectious diseases. However nowadays the majority of under-five year4s deaths are due to respiratory illnesses secondary to respiratory insufficiency. Advanced life support management for critically ill children in resource limited and humanitarian contexts is often non-existent. Development of more effective pediatric emergency and critical care services in developing countries has been identified as crucial to substantially reduce global mortality in young children.

Methods: high flow nasal cannula (HFNC) is a new concept of heated, humidified and blended air/oxygen delivery device able to maintain a continuous distending pressure. It has been successfully implemented in adult, pediatric and transport settings of high-income countries. Although less efficacious than continuous positive airway pressure (CPAP) for severe cases of respiratory insufficiency HFNC has proven superior to O2 by nasal cannula in a number of diseases with respiratory distress syndrome. It also reduces the need for intubations, which in low-income settings equals to the death of the patient.

Results: It has the advantages over CPAP of being easier for installation and maintenance, have less skin and respiratory complications and be better tolerated by the small patient with no need for sedation. In contrast to CPAP, HFNC is implemented in general wards with simpler implementation training. To this date no studies have been finalized in low-income settings, therefore costs and staff investment related to HFNC implementation is unknown.

Conclusion: with the need to further improve the care of pediatric patients we advocate that implementation of HFNC in MSF projects would decrease under five mortality without representing a big burden on equipment and paramedical staff budget. Implementation protocols with proper staff and biomed training as well as further studies will be needed.