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Intensive Care Medicine
Published in: Intensive Care Medicine 9/2016

01-09-2016 | Review

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

Authors: 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

Published in: Intensive Care Medicine | Issue 9/2016

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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 FiO2 (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.
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Metadata
Title
Use of high-flow nasal cannula oxygenation in ICU adults: a narrative review
Authors
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
Publication date
01-09-2016
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 9/2016
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-016-4277-8

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