UMEM Educational Pearls

Category: Critical Care

Title: High Flow Nasal Cannula

Keywords: HFNC, vapotherm, high flow, nasal cannula, hypoxemia (PubMed Search)

Posted: 5/7/2014 by Feras Khan, MD (Updated: 4/25/2024)
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High Flow Nasal Cannula

What is it?

High flow nasal cannula has been used in pediatrics for some time now
It can be used in adults as well
It is a simple nasal cannula setup with larger cannula sizes in both nares
It is heated, humidified oxygen
You can control your oxygen level and flow of oxygen

Benefits

Small amount of PEEP provided to the patient (estimated 5-7 cm H20)
Improves oxygenation (more reliable oxygenation than a non-rebreather face mask)
Can provide some alveolar recruitment
Increases FRC (functional residual capacity)
Pharyngeal dead space washout

Who to use it on

Acute hypoxemic respiratory failure
Pre-intubation (can place before and during intubation in patients who have low oxygen saturation)
Post-extubation
Palliative care (DNI patients)

How to set it

Flow rates: 0-60 L/min
Spontaneously breathing patient with mild-moderate hypoxemia/respiratory distress:

-15-30 L per minute

-100% oxygen (wean as tolerated)

-temp 35-40 C

-when weaning decrease oxygen prior to flow

Bottom line: No evidence that it reduces intubation rates in patients with hypoxemic respiratory failure but may improve oxygenation issues while deciding on treatment options

References

Clinical evidence on high flow oxygen therapy and active humidification in adults

C. Goteraa, S. Di az Lobatoa,∗, T. Pintob, J.C. Winckb

March 2013, Portugese Journal of Pulmonology