High-Flow Nasal Cannula Oxygen in Adult Patients: A Narrative Review

Sotello, David; Rivas, Marcella; Mulkey, Zachary; Nugent, Kenneth

doi:10.1097/maj.0000000000000345

Cited by 43 publications

(21 citation statements)

References 22 publications

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“…HFNC can deliver heated humidified oxygen through nasal prongs and provide much higher and more predictable rates of gas flow (maximum flow of 60 L/min) and fraction of inspired oxygen (FiO 2 ) (up to 1.0) [2–4]. …”

Section: Introductionmentioning

confidence: 99%

“…HFNC has several advantages when compared to conventional oxygen therapy (COT): (1) the high-flow rates match the patient’s inspiratory flow rates, which creates a positive pressure effect [5, 6] and reduces the anatomic dead space [7]; (2) HFNC can deliver a predictable and constant FiO 2 [8]; (3) HFNC can increase the partial arterial pressure of oxygen (PaO 2 )/FIO 2 ratio, which reduces the entrainment of room air and the dilution of oxygen [1, 2]; (4) the heated and humidified gas that is inhaled can improve mucociliary motion and sputum clearance [3, 9]; and (5) there is reduced upper airway resistance, reduced work of breathing [10] and improvement in thoraco-abdominal synchrony [11, 12]. Based on the above advantages, several studies found that HFNC could improve comfort level [13–15], increase oxygenation [12, 14–17] and decrease the dyspnoea score in adult patients [3, 12, 14, 17].…”

Section: Introductionmentioning

confidence: 99%

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High-flow nasal cannula oxygen therapy is superior to conventional oxygen therapy but not to noninvasive mechanical ventilation on intubation rate: a systematic review and meta-analysis

et al. 2017

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BackgroundHigh-flow nasal cannula oxygen (HFNC) is a relatively new therapy used in adults with respiratory failure. Whether it is superior to conventional oxygen therapy (COT) or to noninvasive mechanical ventilation (NIV) remains unclear. The aim of the present study was to investigate whether HFNC was superior to either COT or NIV in adult acute respiratory failure patients.MethodsA review of the literature was conducted from the electronic databases from inception up to 20 October 2016. Only randomized clinical trials comparing HFNC with COT or HFNC with NIV were included. The intubation rate was the primary outcome; secondary outcomes included the mechanical ventilation rate, the rate of escalation of respiratory support and mortality.ResultsEleven studies that enrolled 3459 patients (HFNC, n = 1681) were included. There were eight studies comparing HFNC with COT, two comparing HFNC with NIV, and one comparing all three. HFNC was associated with a significant reduction in intubation rate (OR 0.52, 95% CI 0.34 to 0.79, P = 0.002), mechanical ventilation rate (OR 0.56, 95% CI 0.33 to 0.97, P = 0.04) and the rate of escalation of respiratory support (OR 0.45, 95% CI 0.31 to 0.67, P < 0.0001) when compared to COT. There was no difference in mortality between HFNC and COT utilization (OR 1.01, 95% CI 0.67 to 1.53, P = 0.96). When HFNC was compared to NIV, there was no difference in the intubation rate (OR 0.96; 95% CI 0.66 to 1.39, P = 0.84), the rate of escalation of respiratory support (OR 1.00, 95% CI 0.77 to 1.28, P = 0.97) or mortality (OR 0.85, 95% CI 0.43 to 1.68, P = 0.65).ConclusionsCompared to COT, HFNC reduced the rate of intubation, mechanical ventilation and the escalation of respiratory support. When compared to NIV, HFNC showed no better outcomes. Large-scale randomized controlled trials are necessary to prove our findings.Trial registrationPROSPERO International prospective register of systematic reviews on May 25, 2016 registration no. CRD42016039581.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1760-8) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

High-flow nasal cannula oxygen therapy is superior to conventional oxygen therapy but not to noninvasive mechanical ventilation on intubation rate: a systematic review and meta-analysis

et al. 2017

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“…High-flow nasal cannula (HFNC) delivers heated humidified oxygen up to 100% at a maximum flow rate of 60 L/min of gas via nasal prongs which match patient flow demands better, reduce anatomic dead space, and provides some amount of positive pressure in the airway 70 . In a retrospective single center study of 45 patients with hematologic malignancies and ARF predominantly due to bacterial pneumonia and PCP pneumonia 71 , Lee et al demonstrated that the use of HFNC was feasible, with a failure rate of 67%, similar to that of NIV failure rates reported in previous studies 58,60 .…”

Section: Feasibility Of High-flow Nasal Cannula Oxygen Therapymentioning

confidence: 99%

Management of Acute Respiratory Failure in Patients With Hematological Malignancy

Vadde

Pastores

2016

J Intensive Care Med

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Acute respiratory failure (ARF) is the leading cause of ICU admission in patients with hematologic malignancies and is associated with a high mortality. The main causes of ARF are bacterial and opportunistic pulmonary infections and noninfectious lung disorders. Management consists of a systematic clinical evaluation aimed at identifying the most likely cause, which in turn, determines the best first-line empirical treatments. The need for mechanical ventilation is a major determinant of prognosis. Several studies have demonstrated successful outcomes with early use of noninvasive ventilation in these patients primarily attributed to the reduction of the need for, and complications from, invasive mechanical ventilation.

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“…Clinically, HFNC therapy decreases dyspnea, improves patient's comfort, improves oxygenation and enhances clearance of upper airway secretions [1]. We present preliminary results from a clinical study aimed at measuring the effects of HFNC on gas exchange, lung volumes and inspiratory effort in hypoxemic non-intubated critically ill patients.…”

Section: Introductionmentioning

confidence: 99%

Effects of high-flow nasal cannula therapy on oxygenation, lung volumes and CO2 removal in critically ill hypoxemic patients: preliminary results

et al. 2015

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High-Flow Nasal Cannula Oxygen in Adult Patients: A Narrative Review

Cited by 43 publications

References 22 publications

High-flow nasal cannula oxygen therapy is superior to conventional oxygen therapy but not to noninvasive mechanical ventilation on intubation rate: a systematic review and meta-analysis

High-flow nasal cannula oxygen therapy is superior to conventional oxygen therapy but not to noninvasive mechanical ventilation on intubation rate: a systematic review and meta-analysis

Management of Acute Respiratory Failure in Patients With Hematological Malignancy

Effects of high-flow nasal cannula therapy on oxygenation, lung volumes and CO2 removal in critically ill hypoxemic patients: preliminary results

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