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Changes in the use of humidified high flow nasal cannula oxygen
  1. Sandeep Shetty1,2,
  2. Adesh Sundaresan1,
  3. Katie Hunt2,
  4. Prakash Desai3,
  5. Anne Greenough1,2,4
  1. 1Division of Asthma, Allergy and Lung Biology, MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK
  2. 2Department of Child Health, Neonatal Intensive Care Centre, King's College Hospital, London, UK
  3. 3Neonatal Intensive Care Unit, Chelsea and Westminster Hospital, London, UK
  4. 4NIHR Biomedical Centre at Guy's and St Thomas NHS Foundation Trust and King's College London, London, UK
  1. Correspondence to Professor Anne Greenough, NICU, 4th Floor Golden Jubilee Wing, King's College Hospital, Denmark Hill, London SE5 9RS, UK; anne.greenough{at}

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Humidified high flow nasal cannula (HHFNC) has gained popularity in neonatal care. A systematic review1 of the results of nine trials, which included a total of 1112 infants, however, demonstrated that HHFNC was not superior to other modes of non-invasive ventilation in infants of >28 weeks gestational age. We, therefore, sought to determine whether clinical practice regarding HHFNC had changed since 2012 when all UK units were surveyed2 and also to identify why practitioners preferred HHFNC or continuous positive airway pressure (CPAP).

In 2015, lead clinicians of all 194 UK neonatal units were identified from the National Neonatal Audit Programme, British Association of Perinatal Medicine directory and a departmental database from previous audits. In 2012, practitioners from the then 203 UK neonatal units had been contacted.2 Both surveys included questions on the level of neonatal care, the indications for use of HHFNC and the flow rates used. The 2015 survey also contained questions regarding nasal prong size, weaning policies and HHFNC or CPAP preference (practitioners were given a list of possible reasons to choose from).

There was 100% response rate to both surveys. Use of HHFNC was significantly increased in 2015 compared with 2012 (p<0.001) (table 1). Almost all local neonatal and neonatal intensive care units were using HHFNC in 2015. Fewer units were using HHFNC as an alternative to CPAP or weaning from CPAP (p=0.001), but a greater proportion were using it as the primary support mode post extubation (p=0.001). The 2015 survey highlighted that in 25% of units, the prong size was chosen to fit snugly and occlude the nostril, whereas it is recommended that the fit should be <50% of the nares.3 Thirty-six per cent of units were using HHFNC without guidelines. The highest and lowest flow rates used varied in both surveys, but the magnitude of change of flow when weaning from HHFNC did not differ significantly in the two surveys. In the 2015 survey, weaning the flow in increments of between 0.5 and 1 L/min and 24 hourly was most popular, but there was no consensus. This likely reflects that there is currently no evidence to determine the best weaning strategy from HHFNC.4

Table 1

HHFNC practice in 2012 and 2015, data are displayed as the n (%)

The majority of practitioners preferred HHFNC (table 2). In particular, almost all thought babies achieved full oral feeds by breast or bottle quicker on HHFNC and that it was more comfortable for the baby than CPAP.

Table 2

Preference for CPAP or HHFNC, data are displayed as n (%)*


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  • Contributors AG and SS designed the study. SS, AS and KH collected the data for 2015 survey. SS and PD collected data for the 2012 survey. All the authors were involved in the production of the final manuscript.

  • Funding The research was supported by the National Institute for Health Research Biomedical Research Centre based at Guy's and St Thomas’ NHS Foundation Trust and King's College London.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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