Nasal high flow oxygen therapy during acute admissions or periods of worsening symptoms

Abstract

Purpose of reviewNasal high flow therapy (NHF) is increasingly used in acute care settings. In this review, we consider recent advances in the utilization of NHF in chronic obstructive pulmonary disease (COPD), terminal cancer and symptom management. Considerations around NHF use during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic are also discussed.Recent findingsNHF enables humidification and high flows to be provided together with titrated, supplemental oxygen therapy. Compared to conventional oxygen therapy, NHF improves respiratory physiology by reducing workload, enhancing muco-ciliary clearance and improving dead space washout. Some studies suggest that early use of NHF in people being cared for in the emergency department leads to lower rates of invasive ventilation and noninvasive ventilation. There is also emerging evidence for NHF use in people with COPD and chronic respiratory failure, and in palliative care. NHF is comfortable, well-tolerated and safe for use in the management of breathlessness in people with cancer. NHF can be delivered by face mask to patients with SARS-CoV-2 infection, to ease the burden on critical care resources.SummaryThe evidence base for NHF is rapidly growing and offers promise in relieving troublesome symptoms and for people receiving palliative care.

Palliativmedizinische Aspekte in der klinischen Akut- und Notfallmedizin sowie Intensivmedizin

“…B. Opioide bei Atemnot, Haloperidol bei Übelkeit, Butylscopolamin bei terminaler Rasselatmung) auch maschinelle Unterstützungsmöglichkeiten (z. B. nichtinvasive Beatmung oder High-flow-Sauerstofftherapie) infrage [ 42 , 43 ]. Sollte keine effektive Symptomlinderung gelingen, steht auch die Möglichkeit der gezielten Sedierung am Lebensende (z.…”

Editorial: Breathing problems in focus

“…Nasal high flow (NHF) oxygen therapy has emerged as an important method to provide titrated and more efficient oxygen supplementation, as reviewed by Munsif et al [2]. Advantages include the provision of warm, humidified gas (compared to the cold and dry oxygen of regular low flow therapy) which can improve patient comfort and adherence, as well as the opportunity to use much higher flow rates which can 'wash out' dead space and decrease carbon dioxide retention.…”

“…The net clinical benefit between these advantages and potential adverse effects are discussed by the authors to inform improved management of worsening respiratory failure and symptoms. Of note, high flow oxygen therapy has limited evidence for treating acute hypercapnic respiratory failure, with significant alveolar hypoventilation, where the first-line treatment is noninvasive ventilation (NIV) [2].…”