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.
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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.
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