Is there a place for high-flow oxygen therapy in acute respiratory failure? Yes

Abstract

High-flow nasal cannula (HFNC) oxygen therapy is a recent technique delivering a high flow of heated and humidified gas through large nasal cannula. HFNC is simpler to use and apply than noninvasive ventilation (NIV), is more efficient than standard oxygen and appears to be a good alternative strategy for hypoxemic acute respiratory failure (ARF). HFNC is better tolerated than NIV, delivers high fraction of inspired oxygen (FiO2), generates a low level of positive pressure and provides washout of dead space in the upper airways, thereby improving mechanical pulmonary properties and unloading inspiratory muscles during ARF. A recent multicenter randomized controlled trial showed benefits of HFNC concerning mortality in severe patients with hypoxemic ARF. Conversely, in management of patients with hypoxemic ARF, NIV results have been conflicting. Despite improved oxygenation, NIV delivered with face mask may generate high tidal volumes and subsequent ventilator induced lung injury. In immunosuppressed patients with IRA, HFNC seems more beneficial than NIV but future studies are needed to confirm these results.