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High Flow Nasal Cannula
What is it?
- High flow nasal cannula has been used in pediatrics for some time now
- It can be used in adults as well
- It is a simple nasal cannula setup with larger cannula sizes in both nares
- It is heated, humidified oxygen
- You can control your oxygen level and flow of oxygen
Benefits
- Small amount of PEEP provided to the patient (estimated 5-7 cm H20)
- Improves oxygenation (more reliable oxygenation than a non-rebreather face mask)
- Can provide some alveolar recruitment
- Increases FRC (functional residual capacity)
- Pharyngeal dead space washout
Who to use it on
- Acute hypoxemic respiratory failure
- Pre-intubation (can place before and during intubation in patients who have low oxygen saturation)
- Post-extubation
- Palliative care (DNI patients)
How to set it
- Flow rates: 0-60 L/min
- Spontaneously breathing patient with mild-moderate hypoxemia/respiratory distress:
-15-30 L per minute
-100% oxygen (wean as tolerated)
-temp 35-40 C
-when weaning decrease oxygen prior to flow
Bottom line: No evidence that it reduces intubation rates in patients with hypoxemic respiratory failure but may improve oxygenation issues while deciding on treatment options
References
Clinical evidence on high flow oxygen therapy and active humidification in adults
C. Goteraa, S. Di az Lobatoa,∗, T. Pintob, J.C. Winckb
March 2013, Portugese Journal of Pulmonology