How does high-flow nasal cannula (HFNC) work?
High-flow nasal cannula (HFNC) is a heated and humidified system that allows prescribed fraction of inspired oxygen (FIO2) levels to be delivered at very high flow rates. Let’s now consider how HFNC can help our patients improve their respiratory disease.
There are three main proposed benefits of HFNC:
- Precise oxygen delivery
- Functional residual capacity enhancement
- Dead space washout
Precise oxygen delivery
Traditional nasal cannula delivers flow rates of 2–6 L / min. But patients with respiratory distress can have much higher peak inspiratory flow rates. If the inspiratory flow rate of the patient is greater than what is being provided by the cannula, the patient will entrain room air into the lungs. This results in oxygen dilution, and the patient will not be receiving the precise amount of oxygen that is desired.
When high-flow nasal cannula, or HFNC, is used to deliver oxygen, the flow rates are much higher than can be achieved with traditional nasal cannula. This results in a greater delivery of prescribed oxygen into the lungs, and less entrainment of room air. The oxygen you want to deliver to your patients is not prone to the same effect of dilution!
Functional residual capacity enhancement
HFNC also exerts its effect by providing some variable positive pressure.
When measured with manometers in the posterior oropharynx with closed mouth breathing, the pressures are modest, but the effect nearly goes away when patients open their mouths.
Despite this discrepancy, studies show that the functional residual capacity (FRC) increases by about 25% when HFNC is applied.
Dead space washout
Lastly, when HFNC is applied, the constant high flow of oxygen provides a washout of the anatomical dead space of the oropharynx and proximal tracheobronchial tree, which results in more efficient breathing.
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- 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