PT - JOURNAL ARTICLE AU - Hutchings, F A AU - Hilliard, T N AU - Davis, P J TI - Heated humidified high-flow nasal cannula therapy in children AID - 10.1136/archdischild-2014-306590 DP - 2015 Jun 01 TA - Archives of Disease in Childhood PG - 571--575 VI - 100 IP - 6 4099 - http://adc.bmj.com/content/100/6/571.short 4100 - http://adc.bmj.com/content/100/6/571.full SO - Arch Dis Child2015 Jun 01; 100 AB - Heated humidified high-flow nasal cannula therapy (HHHFNC) was originally described as a mode of respiratory support in premature neonates and is now increasingly used in the management of acute respiratory failure in older infants and children. Heating and humidification of gas mixtures allow comfortable delivery of flow rates that match or exceed the patient's inspiratory flow rate. Emerging evidence from observational studies suggests that the use of HHHFNC therapy may be associated with reduced work of breathing, improved ventilation efficiency and a decreased need for intubation in children with respiratory insufficiency. There are several proposed mechanisms of action, and the potential for provision of unpredictable positive distending pressure has caused concern. Randomised controlled trial evidence comparing clinical outcomes with those achieved using other forms of respiratory support is, however, awaited. We review the proposed mechanisms of actions, indications, advantages and complications of HHHFNC therapy in children and describe our approach to its use in the paediatric ward environment.