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Correspondence |

High-Flow Nasal Cannula Can Be Used Outside the ICUHigh-Flow Cannula Use Outside the ICU FREE TO VIEW

Salvador Díaz-Lobato, MD, PhD; Sagrario Mayoralas Alises, MD, PhD
Author and Funding Information

From the Pneumological Department, Ramón y Cajal Teaching Hospital.

CORRESPONDENCE TO: Salvador Díaz-Lobato, MD, PhD, Pneumological Department, Ramón y Cajal Teaching Hospital, Carretera de Colmenar Viejo, Km 9,100, 28934 Madrid, Spain; e-mail: sdiazlobato@gmail.com


CONFLICT OF INTEREST: None declared.

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


Chest. 2015;148(4):e127. doi:10.1378/chest.15-1212
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To the Editor:

We read with great interest the article recently published in CHEST (July 2015) by Spoletini et al,1 an excellent narrative review about the mechanisms of action and clinical implications of using heated, humidified high-flow nasal cannula (HFNC) oxygenation systems in adults. In their article, the authors make the recommendation that HFNC use on regular wards should be discouraged, especially in patients with severe hypoxemia. However, we do not entirely agree with this comment.

HFNC has demonstrated a number of physiologic effects that make it an active treatment of patients with respiratory failure, both acute and chronic.2 Several studies have shown its usefulness not only in patients with acute hypoxemic respiratory failure or in the postextubation period but also in palliative care, in patients with acute heart failure, and in chronic airway diseases, and its indications are still rising.3 It is used in critical care areas, in the ED, and in wards, and it has been used at home in patients with COPD.4,5 We believe that HFNC is not the key point to take into account to choose where we have to care for a patient, but rather the severity of the clinical picture. We agree that severely ill patients should be treated in critical care units, but we believe less severely ill patients can be treated in lower care complexity areas and wards.

HFNC is a simple and easy technique to apply and is well tolerated by patients. It is an innovative and effective modality for the early treatment of adults with respiratory failure associated with diverse underlying diseases, and this facilitates its early use outside the ICU.

References

Spoletini G, Alotaibi M, Blasi F, Hill NS. Heated humidified high-flow nasal oxygen in adults: mechanisms of action and clinical implications. Chest. 2015;148(1):253-261. [CrossRef] [PubMed]
 
Dysart K, Miller TL, Wolfson MR, Shaffer TH. Research in high flow therapy: mechanisms of action. Respir Med. 2009;103(10):1400-1405. [CrossRef] [PubMed]
 
Gotera C, Díaz Lobato S, Pinto T, Winck JC. Clinical evidence on high flow oxygen therapy and active humidification in adults. Rev Port Pneumol. 2013;19(5):217-227. [CrossRef] [PubMed]
 
Lenglet H, Sztrymf B, Leroy C, Brun P, Dreyfuss D, Ricard JD. Humidified high flow nasal oxygen during respiratory failure in the emergency department: feasibility and efficacy. Respir Care. 2012;57(11):1873-1878. [CrossRef] [PubMed]
 
Carratalá Perales JM, Llorens P, Brouzet B, et al. High-flow therapy via nasal cannula in acute heart failure. Rev Esp Cardiol. 2011;64(8):723-725. [CrossRef] [PubMed]
 

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References

Spoletini G, Alotaibi M, Blasi F, Hill NS. Heated humidified high-flow nasal oxygen in adults: mechanisms of action and clinical implications. Chest. 2015;148(1):253-261. [CrossRef] [PubMed]
 
Dysart K, Miller TL, Wolfson MR, Shaffer TH. Research in high flow therapy: mechanisms of action. Respir Med. 2009;103(10):1400-1405. [CrossRef] [PubMed]
 
Gotera C, Díaz Lobato S, Pinto T, Winck JC. Clinical evidence on high flow oxygen therapy and active humidification in adults. Rev Port Pneumol. 2013;19(5):217-227. [CrossRef] [PubMed]
 
Lenglet H, Sztrymf B, Leroy C, Brun P, Dreyfuss D, Ricard JD. Humidified high flow nasal oxygen during respiratory failure in the emergency department: feasibility and efficacy. Respir Care. 2012;57(11):1873-1878. [CrossRef] [PubMed]
 
Carratalá Perales JM, Llorens P, Brouzet B, et al. High-flow therapy via nasal cannula in acute heart failure. Rev Esp Cardiol. 2011;64(8):723-725. [CrossRef] [PubMed]
 
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