Go With the Flow...
Fri, 02/09/2018 - 12:08am
Benefits of HFHNC
- Decrease dead space by washing out carbon dioxide with higher flow rates
- Positive end expiratory pressure (PEEP) due to high flow rate increasing nasopharyngeal pressures and decreasing resistance resulting in decreased work of breathing
- More constant fraction of inspired oxygen making oxygen delivery more predictable
- Humidification for comfort and enabling the high flow rate
- Increased comfort and patient compliance compared to non-invasive positive pressure ventilation (NIPPV)
Indications for HFHNC
- Non-hypercapnic acute hypoxemic respiratory failure (e.g. pneumonia, asthma, pulmonary edema, pulmonary embolism)
- Pre-intubation and apneic oxygenation due to higher flow rates and FiO2 as compared to regular nasal cannula
- Post-extubation to reduce risk of re-intubation
How to start HFHNC
- Set inspiratory fraction of oxygen (FiO2): 0.21 to 1.0
- Set rate: 2-8 L/min in pediatrics, 16-60 L/min in adults
- Titrate these settings as needed depending on the response of the patient
- Dysart, Kevin et al. Research in high flow therapy: Mechanisms of action. Respiratory Medicine, Volume 103, Issue 10, 1400-1405. Frat JP, Thille AW, Mercat A, et al; FLORALI Study Group; REVA Network. High-flow oxygen through nasal cannula in acute hypoxemia respiratory failure. N Engl J Med. 2015;372(23):2185-2196.
- Hernández G, Vaquero C, González P, et al. Effect of postextubation high-flow nasal cannula vs conventional oxygen therapy on reintubation in low-risk patients: a randomized clinical trial. JAMA. 2016;315(13):1354-1361.