Efficacy of High-Flow Nasal Cannula Therapy in Acute Hypoxemic Respiratory Failure: Decreased Use of Mechanical Ventilation

High-flow nasal cannula (HFNC) oxygen therapy is carried out using an air/oxygen blender, active humidifier, single heated tube, and nasal cannula. Able to deliver adequately heated and humidified medical gas at flows up to 60 L/min, it is considered to have a number of physiological advantages compared with other standard oxygen therapies, including reduced anatomical dead space, PEEP, constant F IO 2 , and good humidification. Although few large randomized clinical trials have been performed, HFNC has been gaining attention as an alternative respiratory support for critically ill patients. Published data are mostly available for neonates. For critically ill adults, however, evidence is uneven because the reports cover various subjects with diverse underlying conditions, such as hypoxemic respiratory failure, exacerbation of COPD, postextubation, preintubation oxygenation, sleep apnea, acute heart failure, and conditions entailing do-not-intubate orders. Even so, across the diversity, many published reports suggest that HFNC decreases breathing frequency and work of breathing and reduces the need for respiratory support escalation. Some important issues remain to be resolved, such as definitive indications for HFNC and criteria for timing the starting and stopping of HFNC and for escalating treatment. Despite these issues, HFNC has emerged as an innovative and effective modality for early treatment of adults with respiratory failure with diverse underlying diseases.

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“…DOI: 10.4187/respcare.04577 earlier, and it has a possibility of decreasing the use of mechanical ventilation. 15 …”

Section: Introductionmentioning

confidence: 99%

High-Flow Nasal Cannula Oxygen Therapy in Adults: Physiological Benefits, Indication, Clinical Benefits, and Adverse Effects

2016

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“…The latter may be due to a lack of predefined discontinuation criteria, distraction and/or missed cues, inexperience with the device and its use, or a desire to avoid escalation due to patient or provider bias. The current studies by Nagata et al, 7 Gaunt et al, 8 Rittayamai et al, 9 and Vargas et al 10 failed to define such abandonment criteria, and in particular, Rittayamai et al 9 acknowledge several such limitations of their study. First, a median 1.5 h elapsed between recognition and implementation of HFNC or conventional oxygen therapy.…”

Section: Cautions and Limitations In The Use Of Hfncmentioning

confidence: 58%

“…However, the limited patient population, comparatively disparate mortality in the shock subgroups, and the non-protective ventilation strategy (average tidal volume [V T ] in excess of 9 mL/kg) in the NIV group preclude a definitive conclusion from these results. In this issue of RESPIRATORY CARE, 5 original research articles by Nagata et al, 7 Gaunt et al, 8 Rittayamai et al, 9 Vargas et al, 10 and Parke et al 11 explore aspects of HFNC ranging from the physiologic basis for its use to the comparative risks, benefits, and clinical efficacy of conventional oxygen therapy, NIV, and HFNC in the acute care setting. In the end, and in the context of conflicting end points, such as length of stay, ventilator-free days, and mortality, prudence suggests a skeptical interpretation of appropriate use for HFNC in patients experiencing acute hypoxemic, non-hypercapnic respiratory failure.…”

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confidence: 99%

A Skeptical Perspective on High-Flow Nasal Cannula in the Treatment of Acute Hypoxemic Respiratory Failure

Roberts

Oeckler

2015

Respir Care

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“…The use of HFNO was associated with lower mortality in hypoxemic respiratory failure 21 . Compared to conventional oxygen therapy, HFNO is associated with decreased risk of subsequent intubation (relative risk [RR] 0.85, 95% confidence interval [CI] 0.74‐0.99) 22 and need for ICU admission 23,24 …”

Section: Intermediate Therapiesmentioning

confidence: 99%

Respiratory support for adult patients with COVID‐19

Pavlov²,

et al. 2020

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The COVID‐19 pandemic is creating unique strains on the healthcare system. While only a small percentage of patients require mechanical ventilation and ICU care, the enormous size of the populations affected means that these critical resources may become limited. A number of non‐invasive options exist to avert mechanical ventilation and ICU admission. This is a clinical review of these options and their applicability in adult COVID‐19 patients. Summary recommendations include: (1) Avoid nebulized therapies. Consider metered dose inhaler alternatives. (2) Provide supplemental oxygen following usual treatment principles for hypoxic respiratory failure. Maintain awareness of the aerosol‐generating potential of all devices, including nasal cannulas, simple face masks, and venturi masks. Use non‐rebreather masks when possible. Be attentive to aerosol generation and the use of personal protective equipment. (3) High flow nasal oxygen is preferred for patients with higher oxygen support requirements. Non‐invasive positive pressure ventilation may be associated with higher risk of nosocomial transmission. If used, measures special precautions should be used reduce aerosol formation. (4) Early intubation/mechanical ventilation may be prudent for patients deemed likely to progress to critical illness, multi‐organ failure, or acute respiratory distress syndrome (ARDS).

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Efficacy of High-Flow Nasal Cannula Therapy in Acute Hypoxemic Respiratory Failure: Decreased Use of Mechanical Ventilation

Cited by 54 publications

References 30 publications

High-Flow Nasal Cannula Oxygen Therapy in Adults: Physiological Benefits, Indication, Clinical Benefits, and Adverse Effects

High-Flow Nasal Cannula Oxygen Therapy in Adults: Physiological Benefits, Indication, Clinical Benefits, and Adverse Effects

A Skeptical Perspective on High-Flow Nasal Cannula in the Treatment of Acute Hypoxemic Respiratory Failure

Respiratory support for adult patients with COVID‐19

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