In this World Shared Practice Forum Podcast, Dr. Padmanabhan Ramnarayan discusses the findings of the clinical trial comparing high-flow nasal cannula (HFNC) therapy to continuous positive airway pressure (CPAP) therapy in pediatric critical care. The trial, which was published in JAMA, explores the effectiveness of HFNC as a non-inferior alternative to CPAP for respiratory support in acutely ill children. Dr. Ramnarayan reviews the trial’s design, key outcomes, and implications for clinical practice, providing valuable insights for healthcare professionals involved in pediatric respiratory care.

LEARNING OBJECTIVES

- Understand the design and methodology of the clinical trial comparing HFNC and CPAP in pediatric critical care

- Identify the primary and secondary outcomes of the trial and their significance

- Discuss the implications of the trial findings for clinical practice and future research in pediatric respiratory care

AUTHORS

Padmanabhan "Ram" Ramnarayan, MBBS, MD, FRCPCH, FFICM

Professor of Paediatric Critical Care

Imperial College London

Jeffrey Burns, MD, MPH

Emeritus Chief

Division of Critical Care Medicine

Department of Anesthesiology, Critical Care and Pain Medicine

Boston Children's Hospital

Professor of Anesthesia

Harvard Medical School

DATE

Initial publication date: August 26, 2025.

ARTICLES REFERENCED

Ramnarayan P, Richards-Belle A, Drikite L, et al. Effect of High-Flow Nasal Cannula Therapy vs Continuous Positive Airway Pressure Therapy on Liberation From Respiratory Support in Acutely Ill Children Admitted to Pediatric Critical Care Units: A Randomized Clinical Trial. JAMA. 2022;328(2):162-172. doi:10.1001/jama.2022.9615

RENOVATE Investigators and the BRICNet Authors, Maia IS, Kawano-Dourado L, et al. High-Flow Nasal Oxygen vs Noninvasive Ventilation in Patients With Acute Respiratory Failure: The RENOVATE Randomized Clinical Trial. JAMA. 2025;333(10):875-890. doi:10.1001/jama.2024.26244

Pelletier JH, Maholtz DE, Hanson CM, et al. Respiratory Support Practices for Bronchiolitis in the Pediatric Intensive Care Unit. JAMA Netw Open. 2024;7(5):e2410746. Published 2024 May 1. doi:10.1001/jamanetworkopen.2024.10746

TRANSCRIPT

https://cdn.bfldr.com/D6LGWP8S/as/whctgh753rgnhc7rxn7w3mn/20250712_WSP_Ramnarayan_Transcript

Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children’s Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access thus at no expense to the user. For further information on how to enroll, please email: [email protected]

CITATION

Ramnarayan P, O'Hara JE, Burns JP. High-Flow Nasal Cannula vs CPAP in Acutely Ill Children. 08/2025. OPENPediatrics. Online Podcast. https://soundcloud.com/openpediatrics/high-flow-nasal-cannula-vs-cpap-in-acutely-ill-children-by-p-ramnarayan-openpediatrics