High flow nasal therapy in perioperative medicine: from operating room to general ward

Andrea Cortegiani, Giuseppe Accurso, Sebastiano Mercadante, Antonino Giarratano, Cesare Gregoretti, Andrea Cortegiani, Giuseppe Accurso, Sebastiano Mercadante, Antonino Giarratano, Cesare Gregoretti

Abstract

Background: High flow nasal therapy (HFNT) is a technique in which humidified and heated gas is delivered to the airways through the nose via small nasal prongs at flows that are higher than the rates generally applied during conventional oxygen therapy. The delivered high flow rates combine mixtures of air and oxygen and enable different inspired oxygen fractions ranging from 0.21 to 1. HFNT is increasingly used in critically ill adult patients, especially hypoxemic patients in different clinical settings.

Main body: Noninvasive ventilation delivers positive pressure (end-expiratory and inspiratory pressures or continuous positive airway pressure) via different external interfaces. In contrast, HFNT produces different physiological effects that are only partially linked to the generation of expiratory positive airway pressure. HFNT and noninvasive ventilation (NIV) are interesting non-invasive supports in perioperative medicine. HFNT exhibits some advantages compared to NIV because HFNT is easier to apply and requires a lower nursing workload. Tolerance of HFNT remains a matter of intense debate, and it may be related to selected parameters. Patients receiving HFNT and their respiratory patterns should be closely monitored to avoid delays in intubation despite correct oxygenation parameters.

Conclusion: HFNT seems to be an interesting noninvasive support in perioperative medicine. The present review provides anesthesiologists with an overview of current evidence and practical advice on the application of HFNT in perioperative medicine in adult patients.

Keywords: Acute respiratory failure; High flow nasal therapy; Noninvasive ventilation; Perioperative medicine.

Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

Written informed consent was obtained from the participants for publication of this article and any accompanying tables/images. A copy of the written consent is available for review by the Editor of this journal.

Competing interests

Andrea Cortegiani is an Associate Editor of BMC Anesthesiology. GA, AG, and SM declare no competing interests. CG received travel cost reimbursement from Fisher & Paykel Healthcare (New Zealand).

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Figures

Fig. 1
Fig. 1
Example of HNFT use for peri-intubation apneic oxygenation. Authors’ own figure

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