Heated, humidified high flow therapy at home setting in children with respiratory failure- Single centre experience

Abstract

Introduction: High flow oxygen therapy (HFNC) is increasingly used in a variety of clinical settings and we looked at the use of HFNC in home settings prescribed by our large tertiary paediatric respiratory unit.

Aims: Understand the indications, treatment goals and prevalence of using home HFNC Understand the clinical course of patients started on home HFNC

Method: This is a Quality Improvement study performing a service review of all the patients who were commenced on home HFNC at our centre from July 2017 to February 2022. The underlying medical condition, indications for HFNC, duration of therapy, equipment details and the details of flow prescription were collected.

Results: 13 cases were identified. The duration for home HFNC ranged from 1-5 years. All cases started home HFNC as part of respiratory active treatment, but 3 cases are currently under palliative care due to medical deterioration.

The underlying conditions in patients on home HFNC were mainly neurological disorders (5 cases) and genetic disorders (4 cases). The reasons to start home HFNC in neurological and genetic patients were mainly due to type 1 respiratory failure (4 neurological cases, 3 genetic cases).

In one child with desmoid neck tumour and tracheostomy, home HFNC was started due to excessive thick tracheal secretions. Airvo device was used in all cases. Most cases started on oxygen (10 cases) at 2L/min.

Two patients who were on home HFNC via tracheostomy stopped as they needed tracheostomy ventilation due to worsening of their respiratory failure

Conclusion: Home HFNC is increasingly being used in a wide variety of conditions There is a need for further studies to look at adverse impact on patient care