The role for high flow nasal cannula as a respiratory support strategy in adults: a clinical practice guideline

Massimo Antonelli, Rochwerg 1 2 Bram, Einav 3 4 Sharon, Chaudhuri 1 Dipayan, Mancebo 5 Jordi, Mauri 6 7 Tommaso, Helviz 3 Yigal, C Goligher 8 9 Ewan, Jaber 10 Samir, Ricard 11 12 Jean-Damien, Rittayamai 13 Nuttapol, Roca 14 15 Oriol, Maurizio Maggiore 18 Salvatore, Demoule 19 20 Alexandre, L Hodgson 21 22 Carol, Mercat 23 Alain, Elizabeth Wilcox 8 9 M, Granton 1 David, Wang 1 Dominic, Azoulay 24 ElieOuanes-Besbes 25 26 Lamia, Cinnella 27 Gilda, Rauseo 27 Michela, Carvalho 28 Carlos, Dessap-Mekontso 29 30 Armand, Fraser 31 32 John, Frat 33 Jean-Pierre, Gomersall 34 Charles, Grasselli 6 7 Giacomo, Hernandez 35 Gonzalo, Jog 36 Sameer, Pesenti 37 Antonio, D Riviello 38 Elisabeth, S Slutsky 9 39 40 Arthur, D Stapleton 41 Renee, Talmor 42 Daniel, W Thille 43 Arnaud, Brochard 9 40 Laurent, Karen E A Burns

Research output: Contribution to journalMeeting Abstract


Purpose: High flow nasal cannula (HFNC) is a relatively recent respiratory support technique which delivers high flow, heated and humidified controlled concentration of oxygen via the nasal route. Recently, its use has increased for a variety of clinical indications. To guide clinical practice, we developed evidence-based recommendations regarding use of HFNC in various clinical settings. Methods: We formed a guideline panel composed of clinicians, methodologists and experts in respiratory medicine. Using GRADE, the panel developed recommendations for four actionable questions. Results: The guideline panel made a strong recommendation for HFNC in hypoxemic respiratory failure compared to conventional oxygen therapy (COT) (moderate certainty), a conditional recommendation for HFNC following extubation (moderate certainty), no recommendation regarding HFNC in the peri-intubation period (moderate certainty), and a conditional recommendation for postoperative HFNC in high risk and/or obese patients following cardiac or thoracic surgery (moderate certainty). Conclusions: This clinical practice guideline synthesizes current best-evidence into four recommendations for HFNC use in patients with hypoxemic respiratory failure, following extubation, in the peri-intubation period, and postoperatively for bedside clinicians.
Original languageEnglish
Pages (from-to)2226-2237
Number of pages12
JournalIntensive Care Medicine
Publication statusPublished - 2020


  • Extubation
  • High flow nasal cannula
  • Mortality
  • Peri-intubation
  • Postoperative
  • Respiratory failure


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