High-Flow Nasal Cannula in a Mixed Adult ICU

A Skeptical Perspective on High-Flow Nasal Cannula in the Treatment of Acute Hypoxemic Respiratory Failure

“…The latter may be due to a lack of predefined discontinuation criteria, distraction and/or missed cues, inexperience with the device and its use, or a desire to avoid escalation due to patient or provider bias. The current studies by Nagata et al, 7 Gaunt et al, 8 Rittayamai et al, 9 and Vargas et al 10 failed to define such abandonment criteria, and in particular, Rittayamai et al 9 acknowledge several such limitations of their study. First, a median 1.5 h elapsed between recognition and implementation of HFNC or conventional oxygen therapy.…”

“…However, the limited patient population, comparatively disparate mortality in the shock subgroups, and the non-protective ventilation strategy (average tidal volume [V T ] in excess of 9 mL/kg) in the NIV group preclude a definitive conclusion from these results. In this issue of RESPIRATORY CARE, 5 original research articles by Nagata et al, 7 Gaunt et al, 8 Rittayamai et al, 9 Vargas et al, 10 and Parke et al 11 explore aspects of HFNC ranging from the physiologic basis for its use to the comparative risks, benefits, and clinical efficacy of conventional oxygen therapy, NIV, and HFNC in the acute care setting. In the end, and in the context of conflicting end points, such as length of stay, ventilator-free days, and mortality, prudence suggests a skeptical interpretation of appropriate use for HFNC in patients experiencing acute hypoxemic, non-hypercapnic respiratory failure.…”

Proactive Use of High-Flow Nasal Cannula With Critically Ill Subjects

“…The control group was composed primarily of subjects who were analyzed in a previous study. 6 The data were reviewed to ensure that all subjects received HFNC as part of escalation of care in the ICU when the O 2 requirement was met (Ͼ4 L/min), and subjects were excluded if HFNC was administered after mechanical ventilation.…”

“…1,2,5 The literature suggests that early HFNC use may result in improved outcomes, but optimal patient characteristics, flows, F IO 2 range, and timing are unclear. 3 Gaunt et al 6 found that subjects who received HFNC earlier rather than later in the hospital stay had reduced ICU and post-ICU lengths of stay, even after controlling for mechanical ventilation. It has been suggested that HFNC could be a first-line therapy for patients with acute hypoxic respiratory failure.…”

“…It has been suggested that HFNC could be a first-line therapy for patients with acute hypoxic respiratory failure. 6,7 SEE THE RELATED EDITORIAL ON PAGE 367 HFNC has been used to resolve postextubation hypoxemia and to prevent re-intubation in certain patient populations because of its ability to reduce upper airway dryness after extubation, improve management of respiratory secretions, and potentially have a protective effect on mucociliary function. 1,[7][8][9][10] In addition, HFNC conditions the inspired gas, allowing for improved oxygenation, and alleviates tracheal mucosa inflammation after intubation.…”