Use of nasal high flow oxygen during acute respiratory failure
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NARRATIVE REVIEW
Use of nasal high flow oxygen during acute respiratory failure Jean‑Damien Ricard1,2* , Oriol Roca3,4, Virginie Lemiale5, Amanda Corley6,7, Jens Braunlich8,9, Peter Jones10,11, Byung Ju Kang12, François Lellouche13, Stefano Nava14, Nuttapol Rittayamai15, Giulia Spoletini16,17, Samir Jaber18 and Gonzalo Hernandez19 © 2020 Springer-Verlag GmbH Germany, part of Springer Nature
Abstract Nasal high flow (NHF) has gained popularity among intensivists to manage patients with acute respiratory failure. An important literature has accompanied this evolution. In this review, an international panel of experts assessed poten‑ tial benefits of NHF in different areas of acute respiratory failure management. Analyses of the physiological effects of NHF indicate flow-dependent improvement in various respiratory function parameters. These beneficial effects allow some patients with severe acute hypoxemic respiratory failure to avoid intubation and improve their outcome. They require close monitoring to not delay intubation. Such a delay may worsen outcome. The ROX index may help clini‑ cians decide when to intubate. In immunocompromised patients, NHF reduces the need for intubation but does not impact mortality. Beneficial physiological effects of NHF have also been reported in patients with chronic respiratory failure, suggesting a possible indication in acute hypercapnic respiratory failure. When intubation is required, NHF can be used to pre-oxygenate patients either alone or in combination with non-invasive ventilation (NIV). Similarly, NHF reduces reintubation alone in low-risk patients and in combination with NIV in high-risk patients. NHF may be used in the emergency department in patients who would not be offered intubation and can be better tolerated than NIV. Keywords: Acute respiratory failure, ARDS, Intubation, High flow oxygen, Nasal canula, Palliative care Introduction In the past years, nasal high flow has gained an important popularity among intensivists to manage patients with acute respiratory failure, filling a gap in the ventilatory support escalation between facemask oxygen and noninvasive or invasive mechanical ventilation. Interestingly, use of NHF was widely and rapidly adopted in ICUs before in-depth knowledge of its physiological effects and evidence of its efficacy were published. Since, a great amount of literature has been published and indications *Correspondence: jean‑[email protected] 1 Medico‑surgical ICU, Assistance Publique ‑ Hôpitaux de Paris, DMU ESPRIT, Médecine Intensive Réanimation, Hôpital Louis Mourier, 92700 Colombes, France Full author information is available at the end of the article
other than acute respiratory failure have emerged. In this narrative review, we have aimed to summarize the available data and address the different clinical scenarios in which NHF can be used, highlighting areas where further research is required to confirm or not the potential for NHF to improve patient outcome.
Nasal High Flow (NHF) in acute hypoxemic respiratory failure (AHRF
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