Recent Applications for High Flow Nasal Oxygen in the Intensive Care Unit

Abstract

High flow nasal cannula oxygen therapy (HFNC) is increasingly used in the intensive care unit (ICU). Recent data suggest that its use can encompass all stages of acute respiratory failure during patients’ ICU stay. During hypoxemic acute respiratory failure, HFNC has shown its efficacy in reducing mortality compared to its association with noninvasive ventilation or to conventional oxygen therapy alone. HFNC enabled a rapid decrease in respiratory distress signs, and an increased tolerance in comparison with these other techniques. Similarly, in immunocompromised patients, very recent data argues for the use of HFNC as a first step therapy. However, the risks of a potential delay in the intubation should be taken into account. As for non invasive ventilation, a predefined algorithm to switch towards invasive ventilation should be adopted. HFNC is used during procedures at risk for desaturation, such as preoxygenation before intubation, although published data are discordant, or to provide oxygen during fiber-optic bronchoscopy with bronchoalveolar lavage. Finally, its usefulness after extubation in ICU patients is now confirmed, compared to noninvasive ventilation for the most severe patients, or conventional oxygen therapy for patients less at-risk. Thus, one might now consider using HFNC for each step of the treatment of an acute respiratory failure patient in the ICU.