Here are three articles to review on the use of high flow nasal oxygen:
High-Flow Nasal Cannula. StatPearls. Sandeep Sharma; Mauricio Danckers; Devang K. Sanghavi; Rebanta K. Chakraborty. Last Update: April 6, 2023.
Continuing Education Activity
Supplemental oxygen therapy is one of the more commonly prescribed interventions used by clinicians when caring for hypoxic patients acutely. This supplementation often takes the form of a low-flow nasal cannula (LFNC). However, there are limitations to this supplemental oxygen intervention. A traditional nasal cannula can only effectively provide only up to 4 to 6 liters per minute of supplemental oxygen. This equates to a FiO2 of approximately 0.37 to 0.45. Above this number, nasal mucosal irritation occurs with the drying of the passages, and there is, therefore, an increased potential for bleeding with prolonged use. In low-flow nasal cannula therapy, FiO2 delivery is directly tied to flow rate. For increased FiO2, the rate must be increased. The low-flow nasal cannula is an open system of supplementation with high levels of leaking air around the oxygen source. As such, the efficacy of treatment for the low-flow nasal cannula is limited. High-flow nasal cannula (HFNC) therapy is an oxygen supply system capable of delivering up to 100% humidified and heated oxygen at a flow rate of up to 60 liters per minute. All settings are controlled independently, allowing for greater confidence in the delivery of supplemental oxygen as well as better outcomes when used. In addition to greater control over the delivery of FiO2, there are several benefits to using a high-flow nasal cannula. The physiological mechanism of action and uses for high-flow nasal cannula are explored. This activity reviews the use of a high flow nasal cannula and the role of the interprofessional team in evaluating and monitoring patients receiving high flow oxygen.
ERS clinical practice guidelines: high-flow nasal cannula in acute respiratory failure. [PubMed Abstract] [Full-Text HTML] [Full-Text PDF]. Eur Respir J. 2022 Apr 14;59(4):2101574. doi: 10.1183/13993003.01574-2021. Print 2022 Apr.
Abstract
Background High-flow nasal cannula (HFNC) has become a frequently used noninvasive form of respiratory support in acute settings; however, evidence supporting its use has only recently emerged. These guidelines provide evidence-based recommendations for the use of HFNC alongside other noninvasive forms of respiratory support in adults with acute respiratory failure (ARF).
Materials and methodology The European Respiratory Society task force panel included expert clinicians and methodologists in pulmonology and intensive care medicine. The task force used the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methods to summarise evidence and develop clinical recommendations for the use of HFNC alongside conventional oxygen therapy (COT) and noninvasive ventilation (NIV) for the management of adults in acute settings with ARF.
Results The task force developed eight conditional recommendations, suggesting the use of 1) HFNC over COT in hypoxaemic ARF; 2) HFNC over NIV in hypoxaemic ARF; 3) HFNC over COT during breaks from NIV; 4) either HFNC or COT in post-operative patients at low risk of pulmonary complications; 5) either HFNC or NIV in post-operative patients at high risk of pulmonary complications; 6) HFNC over COT in nonsurgical patients at low risk of extubation failure; 7) NIV over HFNC for patients at high risk of extubation failure unless there are relative or absolute contraindications to NIV; and 8) trialling NIV prior to use of HFNC in patients with COPD and hypercapnic ARF.
Conclusions HFNC is a valuable intervention in adults with ARF. These conditional recommendations can assist clinicians in choosing the most appropriate form of noninvasive respiratory support to provide to patients in different acute settings.
Appropriate Use of High-Flow Nasal Oxygen in Hospitalized Patients for Initial or Postextubation Management of Acute Respiratory Failure: A Clinical Guideline From the American College of Physicians. [PubMed Abstract] [Full-Text HTML] [Full-Text PDF]. Ann Intern Med. 2021 Jul;174(7):977-984. doi: 10.7326/M20-7533. Epub 2021 Apr 27.
Abstract
Description: The American College of Physicians (ACP) developed this guideline to provide clinical recommendations on the appropriate use of high-flow nasal oxygen (HFNO) in hospitalized patients for initial or postextubation management of acute respiratory failure. It is based on the best available evidence on the benefits and harms of HFNO, taken in the context of costs and patient values and preferences.
Methods: The ACP Clinical Guidelines Committee based these recommendations on a systematic review on the efficacy and safety of HFNO. The patient-centered health outcomes evaluated included all-cause mortality, hospital length of stay, 30-day hospital readmissions, hospital-acquired pneumonia, days of intubation or reintubation, intensive care unit (ICU) admission and ICU transfers, patient comfort, dyspnea, delirium, barotrauma, compromised nutrition, gastric dysfunction, functional independence at discharge, discharge disposition, and skin breakdown. This guideline was developed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method.
Target audience and patient population: The target audience is all clinicians, and the target patient population is adult patients with acute respiratory failure treated in a hospital setting (including emergency departments, hospital wards, intermediate or step-down units, and ICUs).
Recommendation 1a: ACP suggests that clinicians use high-flow nasal oxygen rather than noninvasive ventilation in hospitalized adults for the management of acute hypoxemic respiratory failure (conditional recommendation; low-certainty evidence).
Recommendation 1b: ACP suggests that clinicians use high-flow nasal oxygen rather than conventional oxygen therapy for hospitalized adults with postextubation acute hypoxemic respiratory failure (conditional recommendation; low-certainty evidence).
