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BMC Anesthesiology
Published in: BMC Anesthesiology 1/2018

Open Access 01-12-2018 | Review

High flow nasal therapy in perioperative medicine: from operating room to general ward

Authors: Andrea Cortegiani, Giuseppe Accurso, Sebastiano Mercadante, Antonino Giarratano, Cesare Gregoretti

Published in: BMC Anesthesiology | Issue 1/2018

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Abstract

Background

High flow nasal therapy (HFNT) is a technique in which humidified and heated gas is delivered to the airways through the nose via small nasal prongs at flows that are higher than the rates generally applied during conventional oxygen therapy. The delivered high flow rates combine mixtures of air and oxygen and enable different inspired oxygen fractions ranging from 0.21 to 1. HFNT is increasingly used in critically ill adult patients, especially hypoxemic patients in different clinical settings.

Main body

Noninvasive ventilation delivers positive pressure (end-expiratory and inspiratory pressures or continuous positive airway pressure) via different external interfaces. In contrast, HFNT produces different physiological effects that are only partially linked to the generation of expiratory positive airway pressure. HFNT and noninvasive ventilation (NIV) are interesting non-invasive supports in perioperative medicine. HFNT exhibits some advantages compared to NIV because HFNT is easier to apply and requires a lower nursing workload. Tolerance of HFNT remains a matter of intense debate, and it may be related to selected parameters. Patients receiving HFNT and their respiratory patterns should be closely monitored to avoid delays in intubation despite correct oxygenation parameters.

Conclusion

HFNT seems to be an interesting noninvasive support in perioperative medicine. The present review provides anesthesiologists with an overview of current evidence and practical advice on the application of HFNT in perioperative medicine in adult patients.
Literature
1.
Gregoretti C, Pisani L, Cortegiani A, Ranieri VM. Noninvasive ventilation in critically ill patients. Crit Care Clin. 2015;31:435–57.CrossRef
2.
Spoletini G, Alotaibi M, Blasi F, Hill NS. Heated humidified high-flow nasal oxygen in adults: mechanisms of action and clinical implications. Chest. 2015;148:253–61.CrossRef
3.
Del Sorbo L, Vendramin A, Mehta S. High flow oxygen therapy in adult critically ill patients. Minerva Anestesiol. 2017;83:402–11.PubMed
4.
Sztrymf B, Messika J, Bertrand F, Hurel D, Leon R, Dreyfuss D, et al. Beneficial effects of humidified high flow nasal oxygen in critical care patients: a prospective pilot study. Intensive Care Med. 2011;37:1780–6.CrossRef
5.
Roca O, Masclans JR. High-flow nasal cannula oxygen therapy: innovative strategies for traditional procedures. Crit Care Med. 2015;43:707–8.CrossRef
6.
Frat J-P, Thille AW, Mercat A, Girault C, Ragot S, Perbet S, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med. 2015;372:2185–96.CrossRef
7.
Lee MK, Choi J, Park B, Kim B, Lee SJ, Kim S-H, et al. High flow nasal cannulae oxygen therapy in acute-moderate hypercapnic respiratory failure. Clin Respir J. 2018;12(6):2046–56.CrossRef
8.
Roca O, Riera J, Torres F, Masclans JR. High-flow oxygen therapy in acute respiratory failure. Respir Care. 2010;55:408–13.PubMed
9.
Jaber S, Chanques G, Jung B. Postoperative noninvasive ventilation. Anesthesiology. 2010;112:453–61.CrossRef
10.
Renda T, Corrado A, Iskandar G, Pelaia G, Abdalla K, Navalesi P. High-flow nasal oxygen therapy in intensive care and anaesthesia. Br J Anaesth. 2018;120:18–27.CrossRef
11.
Rochwerg B, Brochard L, Elliott MW, Hess D, Hill NS, Nava S, et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J. European Respiratory Society. 2017;50:1602426.CrossRef
12.
Cortegiani A, Russotto V, Antonelli M, Azoulay E, Carlucci A, Conti G, et al. Ten important articles on noninvasive ventilation in critically ill patients and insights for the future: a report of expert opinions. BMC Anesthesiol. 2017;17:122.CrossRef
13.
Gregoretti C, Cortegiani A, Raineri SM, Giarrjatano A. Noninvasive ventilation in hypoxemic patients: an ongoing soccer game or a lost one? Turk J Anaesth Reanim. 2018;45:329–31.CrossRef
14.
Chanques G, Riboulet F, Molinari N, Carr J, Jung B, Prades A, et al. Comparison of three high flow oxygen therapy delivery devices: a clinical physiological cross-over study. Minerva Anestesiol. 2013;79:1344–55.PubMed
15.
Russotto V, Cortegiani A, Raineri SM, Gregoretti C, Giarratano A. Respiratory support techniques to avoid desaturation in critically ill patients requiring endotracheal intubation: a systematic review and meta-analysis. J Crit Care. 2017;41:98–106.CrossRef
16.
Racca F, Appendini L, Berta G, Barberis L, Vittone F, Gregoretti C, et al. Helmet ventilation for acute respiratory failure and nasal skin breakdown in neuromuscular disorders. Anesth Analg. 2009;109:164–7.CrossRef
17.
Gregoretti C, Confalonieri M, Navalesi P, Squadrone V, Frigerio P, Beltrame F, et al. Evaluation of patient skin breakdown and comfort with a new face mask for non-invasive ventilation: a multi-center study. Intensive Care Med. 2002;28:278–84.CrossRef
18.
Esteban A, Frutos-Vivar F, Ferguson ND, Arabi Y, Apezteguia C, Gonzalez M, et al. Noninvasive positive-pressure ventilation for respiratory failure after extubation. N Engl J Med. 2004;350:2452–60.CrossRef
19.
Kang BJ, Koh Y, Lim C-M, Huh JW, Baek S, Han M, et al. Failure of high-flow nasal cannula therapy may delay intubation and increase mortality. Intensive Care Med. 2015;41:623–32.CrossRef
20.
Nagata K, Morimoto T, Fujimoto D, Otoshi T, Nakagawa A, Otsuka K, et al. Efficacy of high-flow nasal cannula therapy in acute hypoxemic respiratory failure: decreased use of mechanical ventilation. Respir Care. 2015;60:1390–6.CrossRef
21.
Mauri T, Turrini C, Eronia N, Grasselli G, Volta CA, Bellani G, et al. Physiologic effects of high-flow nasal cannula in acute hypoxemic respiratory failure. Am J Respir Crit Care Med. 2017;195:1207–15.CrossRef
22.
Ritchie JE, Williams AB, Gerard C, Hockey H. Evaluation of a humidified nasal high-flow oxygen system, using oxygraphy, capnography and measurement of upper airway pressures. Anaesth Intensive Care. 2011;39:1103–10.PubMed
23.
Wagstaff TAJ, Soni N. Performance of six types of oxygen delivery devices at varying respiratory rates. Anaesthesia. 2007;62:492–503.CrossRef
24.
Sahin-Yilmaz A, Naclerio RM. Anatomy and physiology of the upper airway. Proc Am Thorac Soc. 2011;8:31–9.CrossRef
25.
Dysart K, Miller TL, Wolfson MR, Shaffer TH. Research in high flow therapy: mechanisms of action. Respir Med. 2009;103:1400–5.CrossRef
26.
Shepard JWJ, Thawley SE. Localization of upper airway collapse during sleep in patients with obstructive sleep apnea. Am Rev Respir Dis. 1990;141:1350–5.CrossRef
27.
Gold AR, Smith PL, Schwartz AR. Effect of alae nasi activation on maximal nasal inspiratory airflow in humans. J Appl Physiol (1985). 1998;84:2115–22.CrossRef
28.
Fontanari P, Burnet H, Zattara-Hartmann MC, Jammes Y. Changes in airway resistance induced by nasal inhalation of cold dry, dry, or moist air in normal individuals. J Appl Physiol (1985). 1996;81:1739–43.CrossRef
29.
On LS, Boonyongsunchai P, Webb S, Davies L, Calverley PM, Costello RW. Function of pulmonary neuronal M(2) muscarinic receptors in stable chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001;163:1320–5.CrossRef
30.
Kallstrom TJAARC. Clinical practice guideline: oxygen therapy for adults in the acute care facility--2002 revision & update. Respir Care. 2002;47:717–20.PubMed
31.
Chanques G, Constantin J-M, Sauter M, Jung B, Sebbane M, Verzilli D, et al. Discomfort associated with underhumidified high-flow oxygen therapy in critically ill patients. Intensive Care Med. 2009;35:996–1003.CrossRef
32.
Salah B, Dinh Xuan AT, Fouilladieu JL, Lockhart A, Regnard J. Nasal mucociliary transport in healthy subjects is slower when breathing dry air. Eur Respir J. 1988;1:852–5.PubMed
33.
Kilgour E, Rankin N, Ryan S, Pack R. Mucociliary function deteriorates in the clinical range of inspired air temperature and humidity. Intensive Care Med. 2004;30:1491–4.CrossRef
34.
Mundel T, Feng S, Tatkov S, Schneider H. Mechanisms of nasal high flow on ventilation during wakefulness and sleep. J Appl Physiol (1985). 2013;114:1058–65.CrossRef
35.
Parke R, McGuinness S, Eccleston M. Nasal high-flow therapy delivers low level positive airway pressure. Br J Anaesth. 2009;103:886–90.CrossRef
36.
Spahija J, de Marchie M, Grassino A. Effects of imposed pursed-lips breathing on respiratory mechanics and dyspnea at rest and during exercise in COPD. Chest. 2005;128:640–50.CrossRef
37.
Nakos G, Lachana A, Prekates A, Pneumatikos J, Guillaume M, Pappas K, et al. Respiratory effects of tracheal gas insufflation in spontaneously breathing COPD patients. Intensive Care Med. 1995;21:904–12.CrossRef
38.
Vargas F, Saint-Leger M, Boyer A, Bui NH, Hilbert G. Physiologic effects of high-flow nasal cannula oxygen in critical care subjects. Respir Care. 2015;60:1369–76.CrossRef
39.
Parke RL, Bloch A, McGuinness SP. Effect of very-high-flow nasal therapy on airway pressure and end-expiratory lung impedance in healthy volunteers. Respir Care. 2015;60:1397–403.CrossRef
40.
Moller W, Celik G, Feng S, Bartenstein P, Meyer G, Oliver E, et al. Nasal high flow clears anatomical dead space in upper airway models. J Appl Physiol (1985). 2015;118:1525–32.CrossRef
41.
Braunlich J, Beyer D, Mai D, Hammerschmidt S, Seyfarth H-J, Wirtz H. Effects of nasal high flow on ventilation in volunteers, COPD and idiopathic pulmonary fibrosis patients. Respiration. 2013;85:319–25.CrossRef
42.
Pisani L, Fasano L, Corcione N, Comellini V, Musti MA, Brandao M, et al. Change in pulmonary mechanics and the effect on breathing pattern of high flow oxygen therapy in stable hypercapnic COPD. Thorax. 2017;72:373–5.CrossRef
43.
Fraser JF, Spooner AJ, Dunster KR, Anstey CM, Corley A. Nasal high flow oxygen therapy in patients with COPD reduces respiratory rate and tissue carbon dioxide while increasing tidal and end-expiratory lung volumes: a randomised crossover trial. Thorax. 2016;71:759–61.CrossRef
44.
Mauri T, Alban L, Turrini C, Cambiaghi B, Carlesso E, Taccone P, et al. Optimum support by high-flow nasal cannula in acute hypoxemic respiratory failure: effects of increasing flow rates. Intensive Care Med. 2017;43:1453–63.CrossRef
45.
Mauri T, Galazzi A, Binda F, Masciopinto L, Corcione N, Carlesso E, et al. Impact of flow and temperature on patient comfort during respiratory support by high-flow nasal cannula. Crit Care. 2018;22:120.CrossRef
46.
Nishimura M. High-flow nasal cannula oxygen therapy in adults: physiological benefits, indication, clinical benefits, and adverse effects. Respir Care. 2016;61:529–41.CrossRef
47.
Maitra S, Som A, Bhattacharjee S, Arora MK, Baidya DK. Comparison of high-flow nasal oxygen therapy with conventional oxygen therapy and noninvasive ventilation in adult patients with acute hypoxemic respiratory failure: a meta-analysis and systematic review. J Crit Care. 2016;35:138–44.CrossRef
48.
Lee CC, Mankodi D, Shaharyar S, Ravindranathan S, Danckers M, Herscovici P, et al. High flow nasal cannula versus conventional oxygen therapy and non-invasive ventilation in adults with acute hypoxemic respiratory failure: a systematic review. Respir Med. 2016;121:100–8.CrossRef
49.
Lenglet H, Sztrymf B, Leroy C, Brun P, Dreyfuss D, Ricard J-D. Humidified high flow nasal oxygen during respiratory failure in the emergency department: feasibility and efficacy. Respir Care. 2012;57:1873–8.CrossRef
50.
Schwabbauer N, Berg B, Blumenstock G, Haap M, Hetzel J, Riessen R. Nasal high–flow oxygen therapy in patients with hypoxic respiratory failure: effect on functional and subjective respiratory parameters compared to conventional oxygen therapy and non-invasive ventilation (NIV). BMC Anesthesiol. 2014;14:66.CrossRef
51.
Griesdale DEG, Bosma TL, Kurth T, Isac G, Chittock DR. Complications of endotracheal intubation in the critically ill. Intensive Care Med. 2008;34:1835–42.CrossRef
52.
Mort TC. Preoxygenation in critically ill patients requiring emergency tracheal intubation. Crit Care Med. 2005;33:2672–5.CrossRef
53.
Raineri SM, Cortegiani A, Accurso G, Procaccianti C, Vitale F, Caruso S, et al. Efficacy and safety of using high-flow nasal oxygenation in patients undergoing rapid sequence intubation. Turk J Anaesthesiol Reanim. 2017;45:335–9.CrossRef
54.
Jaber S, Monnin M, Girard M, Conseil M, Cisse M, Carr J, et al. Apnoeic oxygenation via high-flow nasal cannula oxygen combined with non-invasive ventilation preoxygenation for intubation in hypoxaemic patients in the intensive care unit: the single-Centre, blinded, randomised controlled OPTINIV trial. Intensive Care Med. 2016;42:1877–87.CrossRef
55.
Mosier JM, Hypes CD, Sakles JC. Understanding preoxygenation and apneic oxygenation during intubation in the critically ill. Intensive Care Med. 2017;43:226–8.CrossRef
56.
Gander S, Frascarolo P, Suter M, Spahn DR, Magnusson L. Positive end-expiratory pressure during induction of general anesthesia increases duration of nonhypoxic apnea in morbidly obese patients. Anesth Analg. 2005;100:580–4.CrossRef
57.
Futier E, Constantin J-M, Pelosi P, Chanques G, Massone A, Petit A, et al. Noninvasive ventilation and alveolar recruitment maneuver improve respiratory function during and after intubation of morbidly obese patients: a randomized controlled study. Anesthesiology. 2011;114:1354–63.CrossRef
58.
Jaber S, Michelet P, Chanques G. Role of non-invasive ventilation (NIV) in the perioperative period. Best Pract Res Clin Anaesthesiol. 2010;24:253–65.CrossRef
59.
Badiger S, John M, Fearnley RA, Ahmad I. Optimizing oxygenation and intubation conditions during awake fibre-optic intubation using a high-flow nasal oxygen-delivery system. Br J Anaesth. 2015;115:629–32.CrossRef
60.
Heinrich S, Horbach T, Stubner B, Prottengeier J, Irouschek A, Schmidt J. Benefits of heated and humidified high flow nasal oxygen for preoxygenation in morbidly obese patients undergoing bariatric surgery: a randomized controlled study. J Obes Bariatrics. 2014;1:7.
61.
Constantin J-M, Cayot-Constantin S, Roszyk L, Futier E, Sapin V, Dastugue B, et al. Response to recruitment maneuver influences net alveolar fluid clearance in acute respiratory distress syndrome. Anesthesiology. 2007;106:944–51.CrossRef
62.
Patel A, Nouraei SAR. Transnasal humidified rapid-insufflation Ventilatory exchange (THRIVE): a physiological method of increasing apnoea time in patients with difficult airways. Anaesthesia. 2015;70:323–9.CrossRef
63.
Papazian L, Corley A, Hess D, Fraser JF, Frat J-P, Guitton C, et al. Use of high-flow nasal cannula oxygenation in ICU adults: a narrative review. Intensive Care Med. 2016;42:1336–49.CrossRef
64.
Miguel-Montanes R, Hajage D, Messika J, Bertrand F, Gaudry S, Rafat C, et al. Use of high-flow nasal cannula oxygen therapy to prevent desaturation during tracheal intubation of intensive care patients with mild-to-moderate hypoxemia. Crit Care Med. 2015;43:574–83.CrossRef
65.
Vourc'h M, Asfar P, Volteau C, Bachoumas K, Clavieras N, Egreteau P-Y, et al. High-flow nasal cannula oxygen during endotracheal intubation in hypoxemic patients: a randomized controlled clinical trial. Intensive Care Med. 2015;41:1538–48.CrossRef
66.
Simon M, Wachs C, Braune S, de Heer G, Frings D, Kluge S. High-flow nasal cannula versus bag-valve-mask for Preoxygenation before intubation in subjects with hypoxemic respiratory failure. Respir Care. 2016;61:1160–7.CrossRef
67.
Strandberg Å, Tokics L, Brismar B, Lundquist H, Hedenstierna G. Atelectasis during anaesthesia and in the postoperative period. Acta Anaesthesiol Scand. 1986;30:154–8.CrossRef
68.
Duggan M, Kavanagh BP. Pulmonary atelectasis: a pathogenic perioperative entity. Anesthesiology. 2005;102:838–54.CrossRef
69.
Futier E, Marret E, Jaber S. Perioperative positive pressure ventilation: an integrated approach to improve pulmonary care. Anesthesiology. 2014;121:400–8.CrossRef
70.
Magnusson L, Spahn DR. New concepts of atelectasis during general anaesthesia. Br J Anaesth. 2003;91:61–72.CrossRef
71.
Cabrini L, Moizo E, Nicelli E, Licini G, Turi S, Landoni G, et al. Noninvasive ventilation outside the intensive care unit from the patient point of view: a pilot study. Respir Care. 2012;57:704–9.PubMed
72.
Lee JH, Rehder KJ, Williford L, Cheifetz IM, Turner DA. Use of high flow nasal cannula in critically ill infants, children, and adults: a critical review of the literature. Intensive Care Med. 2013;39:247–57.CrossRef
73.
Futier E, Paugam-Burtz C, Godet T, Khoy-Ear L, Rozencwajg S, Delay JM, et al. Effect of early postextubation high-flow nasal cannula vs conventional oxygen therapy on hypoxaemia in patients after major abdominal surgery: a French multicentre randomised controlled trial (OPERA). Intensive Care Med. 2016;42:1888–98.CrossRef
74.
Nava S, Navalesi P, Gregoretti C. Interfaces and humidification for noninvasive mechanical ventilation. Respir Care. 2009;54:71–84.PubMed
75.
Hernandez G, Vaquero C, Gonzalez P, Subira C, Frutos-Vivar F, Rialp G, et al. Effect of Postextubation high-flow nasal cannula vs conventional oxygen therapy on reintubation in low-risk patients: a randomized clinical trial. JAMA. 2016;315:1354–61.CrossRef
76.
Hernandez G, Vaquero C, Colinas L, Cuena R, Gonzalez P, Canabal A, et al. 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. 2016;316:1565–74.CrossRef
77.
Stephan F, Barrucand B, Petit P, Rezaiguia-Delclaux S, Medard A, Delannoy B, et al. High-flow nasal oxygen vs noninvasive positive airway pressure in hypoxemic patients after cardiothoracic surgery: a randomized clinical trial. JAMA. 2015;313:2331–9.CrossRef
78.
Gregoretti C, Cortegiani A, Accurso G, Raineri SM, Giarratano A. Noninvasive ventilation for acute hypoxemic respiratory failure/ARDS: the show must go on. Turk J Anaesth Reanim. 2018;46:1–2
Metadata
Title
High flow nasal therapy in perioperative medicine: from operating room to general ward
Authors
Andrea Cortegiani
Giuseppe Accurso
Sebastiano Mercadante
Antonino Giarratano
Cesare Gregoretti
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2018
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-018-0623-4

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