High-flow nasal cannula (HFNC) is a relatively new device for respiratory support. In pediatrics, HFNC use continues
to increase as the system is easily set up and is well tolerated by patients. The use of nasal cannula adapted to the
infant’s nares size to deliver heated and humidified gas at high flow rates has been associated with improvements
in washout of nasopharyngeal dead space, lung mucociliary clearance, and oxygen delivery compared with other
oxygen delivery systems. HFNC may also create positive pharyngeal pressure to reduce the work of breathing,
which positions the device midway between classical oxygen delivery systems, like the high-concentration face
mask and continuous positive airway pressure (CPAP) generators. Currently, most of the studies in the pediatric
literature suggest the benefits of HFNC therapy only for moderately severe acute viral bronchiolitis. But, the experience
with this device in neonatology and adult intensive care may broaden the pediatric indications to include weaning
from invasive ventilation and acute asthma. As for any form of respiratory support, HFNC initiation in patients requires
close monitoring, whether it be for pre- or inter-hospital transport or in the emergency department or the pediatric
intensive care unit.