Effectiveness and Harms of High-Flow Nasal Oxygen for Acute Respiratory Failure: An Evidence Report for a Clinical Guideline From the American College of Physicians

Baldomero, Arianne K.; Melzer, Anne C.; Greer, Nancy; Majeski, Brittany; MacDonald, Roderick; Linskens, Eric J.; Wilt, Timothy J

doi:10.7326/m20-4675

Cited by 29 publications

(24 citation statements)

References 84 publications

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“…The mechanism might be associated with the following reasons: (1) The modest amount of positive end-expiratory pressure generated by HFNC could greatly flush potential nasopharyngeal dead space, reduce the carbon dioxide levels, as well as improve ventilation and perfusion matching for the obese patients [ 35 ]. (2) HFNC could ameliorate the clearance of respiratory secretions, and reduce the incidence of upper airway obstruction [ 27 ]. (3) HFNC could reduce the work of breathing, and optimize the inspiratory air-flow dynamics and oxygenation in the obese patients [ 36 , 37 ].…”

Section: Discussionmentioning

confidence: 99%

“…Previous meta-analyses assessing the e cacy of HFNC in varied clinical scenarios have been published, including patients with acute respiratory failure, COPD, obesity, and patients with planned extubation in ICU [7,[24][25][26][27]. Of these studies, only two studies explored the application of HFNC in obese patients [7,25].…”

Section: Comparison With Previous Meta-analysesmentioning

confidence: 99%

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Efficacy of High-Flow Nasal Cannula versus Conventional Oxygen Therapy in Obese Patients during the Perioperative Period: A Systematic Review and Meta-Analysis

Zhou

Wang

2022

Canadian Respiratory Journal

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Background. Obesity is a risk factor for severe airway obstruction and hypoxemia. High-flow nasal cannula (HFNC) is considered as a novel method for oxygen therapy, but the efficacy of HFNC for obese patients is controversial. This meta-analysis aimed to assess the efficacy of HFNC compared with conventional oxygen therapy (COT) in obese patients during the perioperative period. Methods. We searched the PubMed, Embase, Web of Science, the Cochrane Library, and Google scholar databases for randomized controlled trials (RCTs) that compared the efficacy of HFNC with COT in obese patients during the perioperative period. The primary outcome was the incidence of hypoxemia, while the secondary outcomes included the lowest SpO2, the need for additional respiratory support, and the hospital length of stay (LOS). Results. Twelve trials with 798 obese patients during the perioperative period were included. Compared with COT, HFNC reduced the incidence of hypoxemia (RR, 0.60; 95% CI, 0.43 to 0.83; P = 0.002 ; I2 = 24%; 8 RCTs; n = 458), increased the lowest SpO2 (MD, 2.88; 95% CI, 1.53 to 4.22; P < 0.0001 ; I2 = 32%; 5 RCTs; n = 264), decreased the need for additional respiratory support (RR, 0.43; 95% CI, 0.21 to 0.88; P = 0.02 ; I2 = 0%; 3 RCTs; n = 305), and shortened the hospital LOS (MD, −0.31; 95% CI, −0.57 to −0.04; P = 0.02 ; I2 = 0%; 3 RCTs; n = 214). Conclusions. This meta-analysis showed that compared with COT, the use of HFNC was able to reduce the incidence of hypoxemia, increase the lowest SpO2, decrease the need for additional respiratory support, and shorten the hospital LOS in obese patients during the perioperative period. Well-organized trials with large sample size should be conducted to support our findings.

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Section: Discussionmentioning

confidence: 99%

Section: Comparison With Previous Meta-analysesmentioning

confidence: 99%

Efficacy of High-Flow Nasal Cannula versus Conventional Oxygen Therapy in Obese Patients during the Perioperative Period: A Systematic Review and Meta-Analysis

Zhou

Wang

2022

Canadian Respiratory Journal

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“…The American College of Physicians has also performed meta-analysis on the effectiveness and harms of HFNC for acute respiratory failure compared with NIV or conventional oxygen therapy [16 ▪ ]. They include the outcomes of comfort and dyspnoea scores in patients with acute respiratory failure.…”

Section: Symptomatic and Physiological Benefit Of High-flow Nasal Can...mentioning

confidence: 99%

Noninvasive respiratory supports for the relief of terminal breathlessness

Inglis

Furst

Foreman

2022

Current Opinion in Supportive &Amp; Palliative Care

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Purpose of reviewBreathlessness is a common symptom in patients with respiratory failure in the terminal phase of their illness. Noninvasive methods of oxygen delivery are frequently used in the palliative setting. We review the evidence supporting noninvasive respiratory supports for the relief of terminal breathlessness in those with life-limiting illnesses. Recent findingsThere is limited evidence to support the use of supplemental oxygen for patients without hypoxia. It is unclear whether the symptomatic benefit of oxygen therapy relates to the oxygen delivery and/or airflow across the nasal mucosa. Early trials suggest that high-flow nasal cannula (HFNC) oxygen therapy improves breathlessness at rest and on exertion for patients with cancer. Noninvasive ventilation (NIV) also appears to improve breathlessness in the palliative setting; however, potential harms include facial pressure injuries, claustrophobia and anxiety. Goals of care should be explicitly discussed and frequently reviewed given that these interventions have the potential for harm and can be challenging to withdraw. SummaryHFNC oxygen therapy and NIV appear to reduce breathlessness in the palliative setting. Further highquality trials are needed to confirm the symptomatic benefits of noninvasive respiratory supports on breathlessness for patients with cancer.

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“…The indication of HFNC is supported by randomized trials and observational studies of patients with hypoxemic respiratory failure. While data are conflicting, these studies consistently demonstrate improved oxygenation and a decreased need for intubation when HFNC is used relative to low-flow oxygen systems [4,5,18,[21][22][23][24][25][26][27][28][29][30][31][32][33][34]. However, studies have failed to show consistent and convincing benefits for mortality, length of ICU and hospital stay, dyspnea, and comfort.…”

Section: Hfnc Versus Low-flow Oxygenmentioning

confidence: 99%

High-flow nasal cannula for respiratory failure in adult patients

Park

2021

Acute Crit Care

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The high-flow nasal cannula (HFNC) has been recently used in several clinical settings for oxygenation in adults. In particular, the advantages of HFNC compared with low-flow oxygen systems or non-invasive ventilation include enhanced comfort, increased humidification of secretions to facilitate expectoration, washout of nasopharyngeal dead space to improve the efficiency of ventilation, provision of a small positive end-inspiratory pressure effect, and fixed and rapid delivery of an accurate fraction of inspired oxygen (FiO2) by minimizing the entrainment of room air. HFNC has been successfully used in critically ill patients with several conditions, such as hypoxemic respiratory failure, hypercapneic respiratory failure (exacerbation of chronic obstructive lung disease), post-extubation respiratory failure, pre-intubation oxygenation, and others. However, the indications are not absolute, and much of the proven benefit remains subjective and physiologic. This review discusses the practical application and clinical uses of HFNC in adults, including its unique respiratory physiologic effects, device settings, and clinical indications.

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Effectiveness and Harms of High-Flow Nasal Oxygen for Acute Respiratory Failure: An Evidence Report for a Clinical Guideline From the American College of Physicians

Cited by 29 publications

References 84 publications

Efficacy of High-Flow Nasal Cannula versus Conventional Oxygen Therapy in Obese Patients during the Perioperative Period: A Systematic Review and Meta-Analysis

Efficacy of High-Flow Nasal Cannula versus Conventional Oxygen Therapy in Obese Patients during the Perioperative Period: A Systematic Review and Meta-Analysis

Noninvasive respiratory supports for the relief of terminal breathlessness

High-flow nasal cannula for respiratory failure in adult patients

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