title: Use of high-flow nasal cannula oxygenation in ICU adults: a narrative review.
abstract: Oxygen therapy can be delivered using low-flow, intermediate-flow (air entrainment mask), or high-flow devices. Low/intermediate-flow oxygen devices have several drawbacks that cause critically ill patients discomfort and translate into suboptimal clinical results. These include limitation of the FiO2 (due to the high inspiratory flow often observed in patients with respiratory failure), and insufficient humidification and warming of the inspired gas. High-flow nasal cannula oxygenation (HFNCO) delivers oxygen flow rates of up to 60 L/min and over the last decade its effect on clinical outcomes has widely been evaluated, such as in the improvement of respiratory distress, the need for intubation, and mortality. Mechanisms of action of HFNCO are complex and not limited to the increased oxygen flow rate. The main aim of this review is to guide clinicians towards evidence-based clinical practice guidelines. It summarizes current knowledge about HFNCO use in ICU patients and the potential areas of uncertainties. For instance, it has been recently suggested that HFNCO could improve the outcome of patients with hypoxemic acute respiratory failure. In other settings, research is ongoing and additional evidence is needed. For instance, if intubation is required, studies suggest that HFNCO may help to improve preoxygenation and can be used after extubation. Likewise, HFNCO might be used in obese patients, or to prevent respiratory deterioration in hypoxemic patients requiring bronchoscopy, or for the delivery of aerosol therapy. However, areas for which conclusive data exist are limited and interventions using standardized HFNCO protocols, comparators, and relevant clinical outcomes are warranted.
authors.affiliation: Réanimation des Détresses Respiratoires et Infections Sévères, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Chemin des Bourrely, 13015, Marseille, France. laurent.papazian@ap-hm.fr.|URMITE UMR CNRS 7278, Faculté de Médecine, Aix-Marseille Université, 13005, Marseille, France. laurent.papazian@ap-hm.fr.
authors.forename: Laurent
authors.initials: L
authors.lastname: Papazian
authors.affiliation: Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Australia.
authors.forename: Amanda
authors.initials: A
authors.lastname: Corley
authors.affiliation: Respiratory Care Department of the Massachusetts General Hospital and the Department of Anesthesia at the Harvard Medical School, Boston, MA, USA.
authors.forename: Dean
authors.initials: D
authors.lastname: Hess
authors.affiliation: Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Australia.
authors.forename: John F
authors.initials: JF
authors.lastname: Fraser
authors.affiliation: CHU de Poitiers, Réanimation Médicale, Poitiers, France.|INSERM, CIC-1402, Université de Poitiers, Poitiers, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Frat
authors.affiliation: Medical ICU, Hôtel-Dieu, University Hospital of Nantes, Nantes, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Guitton
authors.affiliation: Department of Critical Care Medicine and Anesthesiology (DAR B), Research Unit INSERM U1046, Saint Eloi University Hospital and Montpellier School of Medicine, 80 Avenue Augustin Fliche, 34295, Montpellier, France.
authors.forename: Samir
authors.initials: S
authors.lastname: Jaber
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Policlinico SS. Annunziata, Università degli Studi "Gabriele d'Annunzio" Chieti-Pescara, Via dei Vestini, 31, 66100, Chieti, Italy.
authors.forename: Salvatore M
authors.initials: SM
authors.lastname: Maggiore
authors.affiliation: Department of Specialist, Diagnostic and Experimental Medicine, School of Medicine, Respiratory and Critical Care, Sant'Orsola, Malpighi Hospital, Università di Bologna, Bologna, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Nava
authors.affiliation: Medicine Department, CIBERES, Universitat Autonoma de Barcelona, Ps Vall d'Hebron 119, Anexe AG-5a Planta, 08035, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
authors.affiliation: AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, 178 rue des Renouillers, 92700, Colombes, France.|INSERM, IAME, UMR 1137, 75018, Paris, France.|IAME, UMR 1137, Sorbonne Paris Cité, Université Paris Diderot, 75018, Paris, France.
authors.forename: Jean-Damien
authors.initials: JD
authors.lastname: Ricard
authors.affiliation: Service de Réanimation adulte, Hôpital Marie Lannelongue, 133 Avenue de la Résistance, 92350, Le Plessis-Robinson, France.
authors.forename: François
authors.initials: F
authors.lastname: Stephan
authors.affiliation: Interventional Pulmology, Sant'Orsola, Malpighi Hospital, Bologna, Italy.
authors.forename: Rocco
authors.initials: R
authors.lastname: Trisolini
authors.affiliation: AP-HP, Hôpital Saint-Louis, Service de Réanimation Médicale, Sorbonne Paris Cité, Paris Diderot University, Paris, France.
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
mesh_terms: D000328:Adult; D001999:Bronchoscopy / Q000379:methods; D000072601:Cannula; D016638:Critical Illness / Q000628:therapy; D006801:Humans; D000860:Hypoxia / Q000628:therapy*; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000009:adverse effects; D009765:Obesity / Q000150:complications; D010100:Oxygen / Q000097:blood; D010102:Oxygen Inhalation Therapy / Q000295:instrumentation / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012131:Respiratory Insufficiency / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D010100:Oxygen
keywords: Acute respiratory failure; Aerosol; Bronchoscopy; High-flow nasal cannula oxygenation; Non-invasive ventilation; Oxygen therapy