Use of high-flow nasal cannula oxygenation in ICU adults: a narrative review

Laurent Papazian, Amanda Corley, Dean Hess, John F. Fraser, Jean-Pierre Frat, Christophe Guitton, Samir Jaber, Salvatore M. Maggiore, Stefano Nava, Jordi Rello, Jean-Damien Ricard, François Stephan, Rocco Trisolini, Elie Azoulay

Risultato della ricerca: Contributo in rivistaArticolo in rivista

Abstract

Oxygen therapy can be delivered using low-flow, intermediate-flow (air entrainment mask), or high-flow devices. Low/intermediate-flow oxygen devices have several drawbacks that cause critically ill patients discomfort and translate into suboptimal clinical results. These include limitation of the FiO(2) (due to the high inspiratory flow often observed in patients with respiratory failure), and insufficient humidification and warming of the inspired gas. High-flow nasal cannula oxygenation (HFNCO) delivers oxygen flow rates of up to 60 L/min and over the last decade its effect on clinical outcomes has widely been evaluated, such as in the improvement of respiratory distress, the need for intubation, and mortality. Mechanisms of action of HFNCO are complex and not limited to the increased oxygen flow rate. The main aim of this review is to guide clinicians towards evidence-based clinical practice guidelines. It summarizes current knowledge about HFNCO use in ICU patients and the potential areas of uncertainties. For instance, it has been recently suggested that HFNCO could improve the outcome of patients with hypoxemic acute respiratory failure. In other settings, research is ongoing and additional evidence is needed. For instance, if intubation is required, studies suggest that HFNCO may help to improve preoxygenation and can be used after extubation. Likewise, HFNCO might be used in obese patients, or to prevent respiratory deterioration in hypoxemic patients requiring bronchoscopy, or for the delivery of aerosol therapy. However, areas for which conclusive data exist are limited and interventions using standardized HFNCO protocols, comparators, and relevant clinical outcomes are warranted.
Lingua originaleEnglish
pagine (da-a)1336-1349
Numero di pagine14
RivistaIntensive Care Medicine
Volume42
DOI
Stato di pubblicazionePubblicato - 2016

Keywords

  • Acute respiratory failure
  • Aerosol
  • Oxygen therapy
  • High-flow nasal cannula oxygenation
  • Non-invasive ventilation
  • Bronchoscopy

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