High-flow Nasal Cannula: Mechanisms of Action and Adult and Pediatric Indications

Frank J Lodeserto, Thomas M Lettich, Salim R Rezaie, Frank J Lodeserto, Thomas M Lettich, Salim R Rezaie

Abstract

The use of the heated and humidified high-flow nasal cannula has become increasingly popular in the treatment of patients with respiratory failure through all age groups. This article will examine the main mechanisms of actions attributed to the use of the high-flow nasal cannula and review the indications in adult and pediatric populations (outside of the neonatal period). It is unclear which of the mechanisms of action is the most important, but it may depend on the cause of the patient's respiratory failure. This article describes the mechanism of action in an easy to remember mnemonic (HIFLOW); Heated and humidified, meets Inspiratory demands, increases Functional residual capacity (FRC), Lighter, minimizes Oxygen dilution, and Washout of pharyngeal dead space. We will also examine some of the main indications for its use in both the adult and pediatric age groups. The data for the use of high-flow nasal cannula is growing, and currently, some of the main adult indications include hypoxemic respiratory failure due to pneumonia, post-extubation, pre-oxygenation prior to intubation, acute pulmonary edema, and use in patients who are "do not resuscitate or intubate". The main pediatric indication is in infants with bronchiolitis, but other indications are being studied, such as its use in asthma, croup, pneumonia, transport of a critically ill child, and post-extubation.

Keywords: dead space washout; high-flow nasal cannula; oxygen dilution; respiratory failure.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1. Oxygen Dilution
Figure 1. Oxygen Dilution
FiO2: fraction of inspired oxygen; L: liter; NC: nasal cannula Image courtesy of www.rebelem.com
Figure 2. Minimizing Oxygen Dilution
Figure 2. Minimizing Oxygen Dilution
FiO2: fraction of inspired oxygen; L: liter; NC: nasal cannula Image courtesy www.rebelem.com
Figure 3. Mechanisms of Action of Flow
Figure 3. Mechanisms of Action of Flow
FRC: functional residual capacity Image courtesy of www.rebelem.com
Figure 4. Mechanisms of Action of High-Flow…
Figure 4. Mechanisms of Action of High-Flow Nasal Cannula
BiPAP: bilevel positive airway pressure; CO2: carbon dioxide; CPAP: continuous positive airway pressure; FRC: functional residual capacity; PEEP: positive end-expiratory pressure Image courtesy of www.rebelem.com

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