The role for high flow nasal cannula as a respiratory support strategy in adults: a clinical practice guideline

Abstract

Purpose High flow nasal cannula (HFNC) is a relatively recent respiratory support technique which delivers high flow, heated and humidified controlled concentration of oxygen via the nasal route. Recently, its use has increased for a variety of clinical indications. To guide clinical practice, we developed evidence-based recommendations regarding use of HFNC in various clinical settings. Methods We formed a guideline panel composed of clinicians, methodologists and experts in respiratory medicine. Using GRADE, the panel developed recommendations for four actionable questions. Results The guideline panel made a strong recommendation for HFNC in hypoxemic respiratory failure compared to conventional oxygen therapy (COT) (moderate certainty), a conditional recommendation for HFNC following extubation (moderate certainty), no recommendation regarding HFNC in the peri-intubation period (moderate certainty), and a conditional recommendation for postoperative HFNC in high risk and/or obese patients following cardiac or thoracic surgery (moderate certainty). Conclusions This clinical practice guideline synthesizes current best-evidence into four recommendations for HFNC use in patients with hypoxemic respiratory failure, following extubation, in the peri-intubation period, and postoperatively for bedside clinicians. Electronic supplementary material The online version of this article (10.1007/s00134-020-06312-y) contains supplementary material, which is available to authorized users.

Expert consensus statements for the management of COVID-19-related acute respiratory failure using a Delphi method

“…Patients on non-invasive respiratory support need continuous monitoring to avoid any delays in tracheal intubation. A recent clinical practice guideline gave a strong recommendation for the use of HFNO over conventional oxygen therapy in patients with acute hypoxemic respiratory failure (AHRF) to prevent tracheal intubation [ 36 ]. Though there has been conflicting evidence regarding the use of HFNO to prevent invasive mechanical ventilation in C-ARF, experts recommended its use [ 37 – 39 ].…”

COVID-19-associated acute respiratory distress syndrome (CARDS): Current knowledge on pathophysiology and ICU treatment – A narrative review

“…The use of high-flow nasal oxygen (HFNO) in patients with respiratory failure has experienced increased popularity during recent years [ 84 , 85 ]. Even though there is some evidence that HFNO might help to avoid intubation and mechanical ventilation, in some critically ill patients with acute respiratory distress [ 86 ], it may be regarded crucial that patients on HFNO are closely monitored as delayed intubation is associated with worse clinical outcomes [ 84 ].…”

“…Even though there is some evidence that HFNO might help to avoid intubation and mechanical ventilation, in some critically ill patients with acute respiratory distress [ 86 ], it may be regarded crucial that patients on HFNO are closely monitored as delayed intubation is associated with worse clinical outcomes [ 84 ]. HFNO can also be used to supply oxygen during intubation [ 86 ]; however, a recent review and expert panel states that current evidence is not sufficient to recommend the use of HFNO for patients with ARDS in the preintubation period [ 85 ].…”

High-flow nasal oxygen in patients with COVID-19-associated acute respiratory failure

“…High-flow nasal oxygen (HFNO) reduces the need for intubation in adult patients with acute respiratory failure [ 1 – 4 ]. This may in turn help to avoid the associated risks of invasive mechanical ventilation, such as delirium and cognitive impairment, intensive care unit (ICU) acquired weakness and secondary infections.…”