Nasal High Flow for Infants and Children

Guidance from literature suggests two key principles for implementing nasal high flow (NHF) in the care of infants and children: early use and integrated use.1-6 

Queensland Children’s Hospital Documentary Series

The decision for change, the lessons and the significant wins – learn about the implementation of NHF therapy at Queensland Children's Hospital (QCH), formerly known as Lady Cilento Children's Hospital.
NHF in early use for infants

The early use of NHF

The early use of NHF is associated with improved physiological and clinical outcomes compared to standard oxygen therapy, including1-6:

  • improved breathing patterns and rapid unloading of the respiratory muscles
  • significant reduction in the work of breathing 
  • rapid improvement to respiratory distress 
  • reduced need for escalation of therapy in infants with bronchiolitis. 
Integrated use of NHF

The integrated use of NHF

Integrating the use of NHF across the ward (floor), emergency department (ED), and pediatric intensive care units (PICU) may be associated with improved standardization of care.4-6 When used cohesively across the hospital, NHF may also contribute to a change in respiratory support practice, moving towards less invasive strategies and leading to the potential for more patients to be managed in local hospitals and lower acuity settings.4-6
Therefore, the goal should be to use NHF early and in an integrated manner to reduce the risk of escalation of care.1-6

Setting flow rates for infants and children

Clinical evidence supports a dose-by-weight approach with suggested flow rates of approximately 2 liters per kilogram per minute (L/kg/min) for infants between 3.0 and 12.5 kilograms.4,7-12

However, there is no evidence to support this practice for preterm neonates, older children or adults. Published clinical protocols may give guidance to setting flow rates in children.7-12 The graphic below summarizes the findings from published literature.

Setting flow for infants
7-12Published clinical protocols may give guidance in setting flows for infants between 10-12.5kg (purple).
 4,7-12There is sufficient clinical evidence that supports flow rates of 2 L/kg/min (blue) for infants between 3-12.5kg.


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