High-Flow Oxygen Administration by Nasal Cannula for Adult and Perinatal Patients

Abstract

The nasal cannula has been a commonly used patient interface to provide supplemental oxygen since its introduction in the 1940s. Traditionally, it has been categorized as a low-flow device and capable of delivering a 0.4 F IO 2 with flows up to 6 L/min to adults with normal minute ventilation. However, there is considerable performance variability among patients and design, which results in an exponential decline in delivered F IO 2 as breathing frequencies increase. The nasal cannula has also been successfully adapted for use in perinatal and pediatric respiratory care; flows are reduced, in the range of 0.25-1 L/min, due to smaller minute volumes. A decade or so ago, high-flow nasal cannula (HFNC) oxygen therapy was introduced, accompanied by heated humidification systems to prevent the associated drying of upper airway mucosa and to increase patient comfort. Therapeutic flows for adults were in the 15-40 L/min range; F IO 2 could be independently adjusted with air/O 2 blending. The HFNC has also found additional clinical application in perinatal care, as delivery systems with flows > 2 L/min could create a distending pressure similar to nasal CPAP. There is a small but growing body of information from clinical trials that supports use of HFNC as an alternative oxygen interface for adults who present with moderate hypoxemia that persists after receiving oxygen by reservoir-bag masks or similar therapy. Clinical observations report greater patient acceptance and comfort versus oxygen masks. HFNC therapy has also been considered valuable in perinatal care in treating the respiratory distress syndrome or supporting patients after extubation similar to nasal CPAP. At present, research-based evidence for the role of HFNC for its perinatal applications remains unclear. This review will identify proposed mechanisms for therapeutic effectiveness, current delivery equipment, guidelines for rational patient application, and direction for further research.

Safety and Efficacy of High-Flow Nasal Cannula Therapy in Preterm Infants: A Meta-analysis

“…9,53 Extrathoracic anatomic dead space is related to age and is higher in small infants (.3 mL/kg) compared with adults. 54 Thus, continuous washout of this relatively large space with a supply of fresh gas could be of clinical benefit, especially in the neonatal period.…”

“…The most recent mode of respiratory support to be introduced for newborn infants, HHHFNC, however, has quickly gained popularity among clinicians worldwide, [9][10][11][12][13] although evidence supporting its use is not fully established. [14][15][16] Several clinical trials over the last decade have collected evidence of the use of HHHFNC in preterm infants, both as a primary mode of support at birth and after extubation from MV.…”

Right Versus Left Prong Nasal Cannula Flow Delivery and the Effects of Nasal Cycling on Inspired FIO2in an Adult Anatomic Model

“…delivered flow to the patient is affected by the patient's flow pattern, such as the spontaneous inspiratory and expiratory ratio and the patient's nasal, nasopharynx, and oropharynx anatomy. 14 Acknowledging nasal cycling as a persistent physiological event throughout the day and night while keeping in mind the large population of individuals using a nasal cannula for oxygen therapy, the primary aim of this bench study is to evaluate the effects of nasal cycling on the delivered F IO 2 during oxygen administration via nasal cannula at various therapeutic flows to an anatomic model. Additionally, a thorough review of the literature revealed no previous studies comparing right and left prong oxygen flow for nasal cannula adjuncts at various therapeutic flow settings.…”

“…3,4 The nasal cannula is one of the most common oxygen delivery adjuncts used when delivering supplemental oxygen. 14 The nasal cannula is a plastic, disposable, lowflow device used to deliver up to 6 L/min of oxygen. 15 It consists of 7 or 14 feet of crush-resistant small bore oxygen tubing and 2 prongs that are approximately 1 cm in length, which are placed directly into the patient's nares.…”

Improvements in intensive care units

“…If the patient receives FiO 2 of greater than 60% and more than 48 hours, the patient may at risk of oxygen toxicity. Positive pressure ventilation improves oxygenation and CO 2 removal by alveolar recruitment, increasing alveolar volume and redistribution of extracellular lung water, So it is reasonable to use positive pressure in the patient on high O 2 like this level ( Figure 1) [2]. Epistaxis, base of skull fracture, surgery to the nose or upper aero-digestive tract, nasal obstruction; e.g.…”