Treating hypoxic patients with HFNC
Once you’ve gotten the hang of the inner workings of high-flow nasal cannula (HFNC), you’re ready to make the jump to the clinical applications of this oxygen therapy.
Remember that high-flow nasal cannula works by reducing oxygen dilution, improving functional residual capacity (FRC), and creating more efficient breathing through dead space washout.
For a moment, think about a patient you might see presenting with pneumonia. You’ve astutely ordered a chest x-ray, confirmed the diagnoses, and started antibiotics. But your patient’s oxygen saturations continue to drop even when you place them on traditional nasal cannula.
Become a great clinician with our video courses and workshops
Your patient needs more oxygen, but how are you going to deliver it? Turn the regular nasal cannula up? Place the patient on oxygen via facemask? How about a move to noninvasive ventilation (NIV)?
Hopefully you’ve considered high-flow nasal cannula! HFNC has been most robustly studied in patients with hypoxic respiratory failure.
In fact, when put head to head against both traditional oxygen therapy and noninvasive ventilation in patients with hypoxic respiratory failure, HFNC was found to reduce the need for intubation in the sickest patients, and was able to reduce mortality at 90 days.
It is important to understand that these studies were carried out in patients without a number of medical problems—notably heart failure and acute exacerbations of chronic obstructive pulmonary disease (AECOPD). But these patients were very sick, and many had bilateral pneumonias.
That’s it for now. If you want to improve your understanding of key concepts in medicine, and improve your clinical skills, make sure to register for a free trial account, which will give you access to free videos and downloads. We’ll help you make the right decisions for yourself and your patients.
Recommended reading
- Dysart, K, Miller, TL, Wolfson, MR, et al. 2009. Research in high flow therapy: mechanisms of action. Respir Med. 103: 1400–1405. PMID: 19467849
- Frat, JP, Thille, AW, Girault, C, et al. 2015. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med. 372: 2185–2196. PMID: 25981908
- Hernández, G, Vaquero, C, Colinas, L, et al. 2016. Effect of postextubation high-flow nasal cannula vs noninvasive ventilation on reintubation and postextubation respiratory failure in high-risk patients: a randomized clinical trial. JAMA. 316: 1565–1574. PMID: 27706464
- Hernández, G, Vaquero, C, González, P, et al. 2016. Effect of postextubation high-flow nasal cannula vs conventional oxygen therapy on reintubation in low-risk patients: a randomized clinical trial. JAMA. 315: 1354–1361. PMID: 26975498
- Maggiore, SM, Idone, FA, Vaschetto, R, et al. 2014. Nasal high-flow versus venturi mask oxygen therapy after extubation. Effects of oxygenation, comfort and clinical outcome. Am J Respir Crit Care Med. 190: 282–288. PMID: 25003980
- Mauri, T, Turrini, C, Eronia, N, et al. 2017. Physiologic effects of high-flow nasal cannula in acute hypoxemic respiratory failure. Am J Respir Crit Care Med. 195: 1207–1215. PMID: 27997805
- Roca, O, Caralt, B, Messika, J, et al. 2019. An index combining respiratory rate and oxygenation to predict outcome of nasal high-flow therapy. Am J Respir Crit Care Med. 199: 1368–1376. PMID: 30576221
- Roca, O, Messika, J, Caralt, B, et al. 2016. Predicting success of high-flow nasal cannula in pneumonia patients with hypoxemic respiratory failure: the utility of the ROX index. J Crit Care. 35: 200–205. PMID: 27481760
- Sztrymf, B, Messika, J, Bertrand, F, et al. 2011. Beneficial effects of humidified high flow nasal oxygen in critical care patients: a prospective pilot study. Intensive Care Med. 37: 1780–1786. PMID: 21946925