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 In this context, both nasal continuous positive airways pressure (nCPAP) and HFNC can be provided by stand-alone machines, and have been adapted for use in low-resource settings.
HFNC is also being used more frequently in older children,  where it has been shown to be as effective as nCPAP for some conditions.
The probable mechanisms of action of HFNC include heating and humidification of inspired air, nasopharyngeal carbon dioxide wash out, reduction in upper airway resistance, and provision of positive distending pressure.
A pioneering, contextually relevant study from Bangladesh showed that outcomes in terms of 'treatment failure' (defined as two or three of the following characteristics: severe hypoxia, signs of severe clinical distress, or respiratory acidosis on blood gas analysis) were no worse in patients with severe pneumonia who received HFNC than in those who received bubble CPAP, but mortality rates were higher in the low-flow nasal cannula (LFNC) and HFNC groups, indicating a potential risk of harm associated with these modalities.
In the first group, they received NCPAP (Dragger, Lubeck, Germany) after extubation, while group 2 received HFNC (Fisher & Paykel Healthcare, Aukland, New Zealand).
As shown in figure 1, 18 out of 54 included infants (33%) failed and required reintubation in INSURE method, which was higher in the HFNC group (14 vs.
Jamie Fierce of Hasbro Children's Hospital, adding that the 2014 American Academy of Pediatrics guidelines on bronchiolitis called for more research on the efficacy of HFNC (Pediatrics 2014;134:el474-502).
When the data were analysed by correlating individual students' scores and socio-economic status (approximated using the Index of Urban Advantage and the school postcode), the correlation was positive and statistically significant for the students in the entire study, and also for the government, Catholic and HFNC school sectors.
As a result, HFNC oxygen therapy was initiated at 30 L/min with a fraction of inspired oxygen (Fi[O.sub.2]) of 0.30 according to the instructions of the intensivists and anesthesiologists.
A few studies comparing HFNC and conventional oxygen therapy in patients with cardiac or abdominal surgery have been published in the last five years.
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