---
title: "High-Flow Nasal Cannula (HFNC) Outside PICU for Children >1 Year: Narrative Review Summary"
id: "pubmed-42698348"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42698348"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42698348/"
doi: "10.1111/jpc.70572"
published_at: "2026-09-05T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# High-Flow Nasal Cannula (HFNC) Outside PICU for Children >1 Year: Narrative Review Summary
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42698348
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42698348/)
- **DOI:** [10.1111/jpc.70572](https://doi.org/10.1111%2Fjpc.70572)
- **Published At:** 2026-09-05T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This narrative review examines evidence for **high-flow nasal cannula (HFNC)** therapy used outside paediatric intensive care units (PICUs) in children older than 12 months with acute respiratory distress. - The review addressed a literature search of PubMed, Scopus and Medline (OVID) up to October 2025 focused on emergency department and ward settings. - Eight studies met inclusion: six randomised controlled trials, one pilot RCT and one observational cohort. - Conditions covered included **asthma**, **pneumonia** and mixed hypoxaemic respiratory failure rather than bronchiolitis or neonatal populations. - Small trials demonstrated early physiological improvements with HFNC but did not show consistent benefits in hospital length of stay or PICU admission. - Flow rates used across studies were highly variable; several trials delivered flows below thresholds commonly considered necessary to achieve a true high-flow physiological effect. - The largest included trial reported longer hospital stay and higher PICU admission rates when **HFNC** was used early compared with conventional oxygen therapy. - Overall safety and tolerability of HFNC in these settings appeared acceptable in the included studies. - The authors conclude there is insufficient evidence to support routine first-line use of HFNC outside PICU in children over 1 year. - They emphasise the need for further prospective research to define which patient groups may benefit and recommend institution-level policies, clear escalation criteria and close monitoring where HFNC is used outside the PICU.
## Clinical Analysis & Structured Key Points
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Online ahead of print. # High-Flow Nasal Cannula Use for Respiratory Support Outside the Paediatric Intensive Care Unit in Children Over 1 Year: A Narrative Review [Eimear O'Connell](https://pubmed.ncbi.nlm.nih.gov/?term=O%27Connell+E&cauthor_id=42698348)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42698348/#full-view-affiliation-1 "Department of Paediatric Respiratory Medicine, Children's Health Ireland at Crumlin, Dublin, Ireland.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42698348/#full-view-affiliation-2 "School of Medicine, University College Dublin, Dublin, Ireland."), [Des W Cox](https://pubmed.ncbi.nlm.nih.gov/?term=Cox+DW&cauthor_id=42698348)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42698348/#full-view-affiliation-1 "Department of Paediatric Respiratory Medicine, Children's Health Ireland at Crumlin, Dublin, Ireland.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42698348/#full-view-affiliation-2 "School of Medicine, University College Dublin, Dublin, Ireland.") Affiliations Expand ### Affiliations * 1 Department of Paediatric Respiratory Medicine, Children's Health Ireland at Crumlin, Dublin, Ireland. * 2 School of Medicine, University College Dublin, Dublin, Ireland. * PMID: **42698348** * DOI: [ 10.1111/jpc.70572 ](https://doi.org/10.1111/jpc.70572) Item in Clipboard Review # High-Flow Nasal Cannula Use for Respiratory Support Outside the Paediatric Intensive Care Unit in Children Over 1 Year: A Narrative Review Eimear O'Connell et al. J Paediatr Child Health. 2026. Show details Display options Display options Format Abstract PubMed PMID J Paediatr Child Health Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22J+Paediatr+Child+Health%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22J+Paediatr+Child+Health%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42698348/) . 2026 Sep 5. doi: 10.1111/jpc.70572. Online ahead of print. ### Authors [Eimear O'Connell](https://pubmed.ncbi.nlm.nih.gov/?term=O%27Connell+E&cauthor_id=42698348)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42698348/#short-view-affiliation-1 "Department of Paediatric Respiratory Medicine, Children's Health Ireland at Crumlin, Dublin, Ireland.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42698348/#short-view-affiliation-2 "School of Medicine, University College Dublin, Dublin, Ireland."), [Des W Cox](https://pubmed.ncbi.nlm.nih.gov/?term=Cox+DW&cauthor_id=42698348)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42698348/#short-view-affiliation-1 "Department of Paediatric Respiratory Medicine, Children's Health Ireland at Crumlin, Dublin, Ireland.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42698348/#short-view-affiliation-2 "School of Medicine, University College Dublin, Dublin, Ireland.") ### Affiliations * 1 Department of Paediatric Respiratory Medicine, Children's Health Ireland at Crumlin, Dublin, Ireland. * 2 School of Medicine, University College Dublin, Dublin, Ireland. * PMID: **42698348** * DOI: [ 10.1111/jpc.70572 ](https://doi.org/10.1111/jpc.70572) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Aims:** High-flow nasal cannula (HFNC) therapy is increasingly used outside paediatric intensive care units (PICUs) for children with acute respiratory distress, despite limited evidence beyond bronchiolitis and neonatal populations. No existing review has synthesised evidence in children over 1 year without bronchiolitis managed in emergency department and ward settings. This narrative review aims to address this gap. **Methods:** PubMed, Scopus and Medline (OVID) were searched to October 2025 for studies of HFNC in children aged over 12 months with acute respiratory distress, managed in emergency department or ward settings and compared with conventional oxygen therapy or non-invasive ventilation. **Results:** Eight studies (six randomised trials, one pilot RCT, one observational cohort) were included, covering asthma, pneumonia and mixed hypoxaemic respiratory failure. Small trials showed early physiological improvement without consistent benefit in length of stay or PICU admission. Flow rates were highly variable, with several studies delivering flow below thresholds considered necessary for a true high-flow effect. The largest trial reported longer hospital stay and higher PICU admission with early HFNC use compared to conventional oxygen therapy. **Conclusion:** Overall, while HFNC appears safe and well tolerated, current evidence does not support routine first-line use outside the PICU in children over 1 year. More prospective research is urgently needed to identify which populations will benefit from HFNC use. Until such data is available, HFNC should be implemented with clear institutional guidelines, defined escalation criteria and close clinical monitoring. **Keywords:** acute hypoxaemic respiratory failure; asthma; high‐flow nasal cannula; non‐invasive ventilation; pneumonia; respiratory distress. © 2026 Paediatrics and Child Health Division (The Royal Australasian College of Physicians). [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## References 1. 1. J. Li, N. Deng, W. J. A. He, et al., “The Effects of Flow Settings During High‐Flow Nasal Cannula Oxygen Therapy for Neonates and Young Children,” European Respiratory Review 33 (2024): 230223, [https://doi.org/10.1183/16000617.0223‐2023](https://doi.org/10.1183/16000617.0223%E2%80%902023). 2. 1. M. Frizzola, T. L. Miller, M. E. Rodriguez, et al., “High‐Flow Nasal Cannula: Impact on Oxygenation and Ventilation in an Acute Lung Injury Model,” Pediatric Pulmonology 46 (2011): 67–74, . 3. 1. K. Dysart, T. L. Miller, M. R. Wolfson, and T. H. Shaffer, “Research in High Flow Therapy: Mechanisms of Action,” Respiratory Medicine 103 (2009): 1400–1405, . 4. 1. R. A. Hasan and R. H. Habib, “Effects of Flow Rate and Airleak at the Nares and Mouth Opening on Positive Distending Pressure Delivery Using Commercially Available High‐Flow Nasal Cannula Systems: A Lung Model Study,” Pediatric Critical Care Medicine 12 (2011): e29–e33, . 5. 1. S. Nolasco, S. Manti, S. Leonardi, C. Vancheri, and L. Spicuzza, “High‐Flow Nasal Cannula Oxygen Therapy: Physiological Mechanisms and Clinical Applications in Children,” Frontiers in Medicine 9 (2022): 920549, . 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