High-flow nasal cannula therapy for support of breathing in children

We reviewed evidence on the effectiveness of high-flow nasal cannula (HFNC) therapy in supporting children's breathing. We found 11 studies in children.


HFNC therapy delivers a mixture of air and oxygen via tubing that sits just inside the nostrils. For children hospitalized with breathing difficulties caused by conditions such as pneumonia or trauma or after surgery, HFNC therapy may help to support their breathing. This may reduce the need for other forms of breathing support such as life support. HFNC therapy can be used within the hospital ward setting, the emergency department or the intensive care unit. This Cochrane review is important because it assesses available evidence on the safety and effectiveness of HFNC compared with other forms of respiratory support, to help inform clinicians caring for children with breathing difficulties.

Search date

We searched medical databases from the 1950s until April 2013.

Study characteristics

We included studies on children from four weeks to 16 years of age. We searched for randomized controlled trials; however we excluded studies involving infants with bronchiolitis (a respiratory illness affecting infants that typically mimics a common cold) because children with this condition are included in another Cochrane review.


We found 11 studies involving children; however none matched our criteria.


It is important that good-quality studies are completed to identify indications as to the use and effectiveness of HFNC therapy in supporting the breathing of ill children.

Authors' conclusions: 

Based on the results of this review, no evidence is available to allow determination of the safety or effectiveness of HFNC as a form of respiratory support in children.

Read the full abstract...

Respiratory support is a central component of the management of critically ill children. It can be delivered invasively via an endotracheal tube or non-invasively via face mask, nasal mask, nasal cannula or oxygen hood/tent. Invasive ventilation can be damaging to the lungs, and the tendency to use non-invasive forms is growing. However, non-invasive delivery is often poorly tolerated by children. High-flow nasal cannula (HFNC) oxygen delivery is a relatively new therapy that shows the potential to reduce the need for intubation and be better tolerated by children than other non-invasive forms of support. HFNC therapy differs from other non-invasive forms of treatment in that it delivers heated, humidified and blended air/oxygen via nasal cannula at rates > 2 L/kg/min. This allows the user to deliver high concentrations of oxygen and to potentially deliver continuous distending pressure; this treatment often is better tolerated by the child.


To determine whether HFNC therapy is more effective than other forms of non-invasive therapy in paediatric patients who require respiratory support.

Search strategy: 

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2013, Issue 4); MEDLINE via PubMed (January 1966 to April 2013); EMBASE (January 1980 to April 2013); CINAHL (1982 to April 2013); and LILACS (1982 to April 2013). Abstracts from conference proceedings, theses and dissertations and bibliographical references to relevant studies were also searched. We applied no restriction on language.

Selection criteria: 

We planned to included randomized controlled trials (RCTs) and quas-randomized trials comparing HFNC therapy with other forms of non-invasive respiratory support for children. Non-invasive support encompassed cot, hood or tent oxygen; low-flow nasal cannulae (flow rates ≤ 2 L/min); and continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) delivered via facial or nasal mask/cannula. Treatment failure was defined by the need for additional respiratory support. We excluded children with a diagnosis of bronchiolitis.

Data collection and analysis: 

Two review authors independently assessed all studies for selection and data extraction. We used standard methodological procedures expected by The Cochrane Collaboration.

Main results: 

Our search yielded 922 records. A total of 109 relevant records were retrieved with reference to our search criteria. After duplicates and irrelevant studies were removed, 69 studies were further scrutinized. Of these, 11 studies involved children. No study matched our inclusion criteria.