High Flow Nasal Cannula
High flow nasal cannula represents a therapy which takes advantage of high flows of air and blended oxygen to provide respiratory support
High Flow Nasal Cannula Overview
Advantages:
- More comfortable silicon-based nasal cannula
- High flows may help washout the airways and may decrease dead-space
- Higher flows can deliver positive airway pressure (estimated 1cmH2O for every 10 litres/minute of flow)
- Humidification may improve mucociliary clearance
Indications:
- Hypoxic respiratory failure (infective, post-operative, exacerbation of chronic airway diseases)
- Pre-oxygenation strategy prior to intubation
- Restrictive lung disease
- Neuromuscular disease (e.g. Guillain-Barre syndrome, motor neuron disease)
- Palliative setting
- Hypercapnic respiratory failure (use with caution – may be more reserved for treatment failure on NIV)
Contraindications:
- Recent surgery to nose/aerodigestive tract
- Base of skull fracture
- Epistaxis
- Pneumothorax or penetrating lung injury without intercostal catheter
- Significant gastric distension
Take-home points:
- Use appropriate flow rates (at least 30-40L) to ensure the benefits of this treatment are obtained
- Prescribe the target FiO2 and SpO2 so that the high flow therapy can be titrated properly
- Be aware of the failing or deteriorating patient, and plan for treatment escalation if required
References
- Nickson C. High-flow nasal cannula LITFL
- Helviz Y, Einav S. A Systematic Review of the High-flow Nasal Cannula for Adult Patients. Crit Care 2018; 22: 71
- 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 Oct;60(10):1397-403
- Li J, Albuainain FA, Tan W, Scott JB, Roca O, Mauri T. The effects of flow settings during high-flow nasal cannula support for adult subjects: a systematic review. Crit Care. 2023 Feb 28;27(1):78.
Emergency Procedures
Physician in training. German translator and lover of medical history.
Chris is an Emergency Medicine Specialist with an interest in diagnostic and procedural ultrasound. He works at Sir Charles Gairdner Hospital in Perth, Western Australia. In addition to working in a tertiary Emergency Department he has experience in retrieval medicine with Royal Flying Doctor Service Western Operations, acute patient transport co-ordination with WA Country Health Service and in education as director of MedVault Education in Association with the Australian Medical Association WA.