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

Abstract

Extubation to HFNC led to a significant decrease in pulmonary infections and bronchodilator therapy in Cohort 1 but did not reduce length of stay or rates of failed extubation. When HFNC was used early and per protocol (Cohort 2), ICU and hospital lengths of stay were reduced and HFNC was initiated more quickly when the need for respiratory support escalated.

How to use humidified high‐flow nasal cannula in breathless adults in the emergency department

“…HHFNC is seen as a useful therapy providing some degree of respiratory support, thus bridging the dyspnoea management gap between early oxygen therapy and non‐invasive ventilation (NIV) or intubation …”

“…HHFNC is seen as a useful therapy providing some degree of respiratory support, thus bridging the dyspnoea management gap between early oxygen therapy and non-invasive ventilation (NIV) or intubation. [3][4][5] Current management of breathlessness in the ED is a sequential treatment ladder, progressing incrementally from low-flow nasal oxygen supplementation, via simple facemasks through non-rebreathing facemasks, to NIV and intubation (ETT) and/or front of neck access (FONA). Definitive treatments for the undifferentiated breathless patient are provided as indicated, with nebuliser therapy for bronchoconstriction, continuous positive airway pressure for pulmonary oedema, biphasic respiratory support or intubation for ventilatory insufficiency or FONA for obstruction.…”

High-Flow Nasal Cannula: Where Does It Fit?

“…In this issue of RESPIRATORY CARE, Lamb and coworkers examine clinical application of HFNC in subjects following extubation and as an escalation therapy prior to intubation in individuals with progressive respiratory insufficiency. 2 Historical controls were employed. The first study cohort had received mechanical ventilation for at least 24 h and was extubated directly to HFNC.…”

“…The second cohort of subjects was evaluated with an HFNC protocol employed as oxygen requirements escalated prior to intubation. 2 HFNC subjects moved more rapidly to intubation when this technology failed, and there was a trend toward fewer hours utilizing HFNC in subjects who required increasing oxygen therapy. When intubated, subjects who were on HFNC required significantly fewer days in the ICU and in hospital.…”

Implementation of High-Flow Nasal Cannula Therapy Outside the Intensive Care Setting

“…High-flow nasal cannula (HFNC) therapy has become an increasingly popular form of respiratory support for ICU patients with worsening hypoxic respiratory failure. [14][15][16][17][18][19][20][21] There are many advantages of HFNC, including ease of use, patient comfort, and efficient delivery of humidified highflow oxygen. [22][23][24][25][26] In many hospitals, HFNC is available only in the ICU setting, but this restriction can delay treatment if there are no available ICU beds and may result in a loweracuity patient being moved to the ICU only to receive treatment.…”