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Contemporary Reviews in Critical Care Medicine |

Heated Humidified High-Flow Nasal Oxygen in AdultsHigh-Flow Nasal Oxygen: Mechanisms of Action and Clinical Implications

Giulia Spoletini, MD; Mona Alotaibi, MD; Francesco Blasi, MD; Nicholas S. Hill, MD, FCCP
Author and Funding Information

From the Department of Pathophysiology and Transplantation (Drs Spoletini and Blasi), Università degli Studi di Milano, IRCCS Fondazione Ospedale Maggiore Policlinico Cà Granda, Milan, Italy; Department of Internal Medicine (Dr Alotaibi), University Hospital Case Medical Center, Cleveland, OH; and Division of Pulmonary, Critical Care and Sleep Medicine (Dr Hill), Tufts Medical Center, Boston, MA.

CORRESPONDENCE TO: Nicholas S. Hill, MD, FCCP, Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, 800 Washington St, #257, Boston, MA 02111; e-mail: nhill@tuftsmedicalcenter.org


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(1):253-261. doi:10.1378/chest.14-2871
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Traditionally, nasal oxygen therapy has been delivered at low flows through nasal cannulae. In recent years, nasal cannulae designed to administer heated and humidified air/oxygen mixtures at high flows (up to 60 L/min) have been gaining popularity. These high-flow nasal cannula (HFNC) systems enhance patient comfort and tolerance compared with traditional high-flow oxygenation systems, such as nasal masks and nonrebreathing systems. By delivering higher flow rates, HFNC systems are less apt than traditional oxygenation systems to permit entrainment of room air during patient inspiration. Combined with the flushing of expired air from the upper airway during expiration, these mechanisms assure more reliable delivery of high Fio2 levels. The flushing of upper airway dead space also improves ventilatory efficiency and reduces the work of breathing. HFNC also generates a positive end-expiratory pressure (PEEP), which may counterbalance auto-PEEP, further reducing ventilator work; improve oxygenation; and provide back pressure to enhance airway patency during expiration, permitting more complete emptying. HFNC has been tried for multiple indications, including secretion retention, hypoxemic respiratory failure, and cardiogenic pulmonary edema, to counterbalance auto-PEEP in patients with COPD and as prophylactic therapy or treatment of respiratory failure postsurgery and postextubation. As of yet, very few high-quality studies have been published evaluating these indications, so recommendations regarding clinical applications of HFNC remain tentative.

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