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Use of nasal high flow oxygen during acute respiratory failure

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Abstract

Nasal high flow (NHF) has gained popularity among intensivists to manage patients with acute respiratory failure. An important literature has accompanied this evolution. In this review, an international panel of experts assessed potential benefits of NHF in different areas of acute respiratory failure management. Analyses of the physiological effects of NHF indicate flow-dependent improvement in various respiratory function parameters. These beneficial effects allow some patients with severe acute hypoxemic respiratory failure to avoid intubation and improve their outcome. They require close monitoring to not delay intubation. Such a delay may worsen outcome. The ROX index may help clinicians decide when to intubate. In immunocompromised patients, NHF reduces the need for intubation but does not impact mortality. Beneficial physiological effects of NHF have also been reported in patients with chronic respiratory failure, suggesting a possible indication in acute hypercapnic respiratory failure. When intubation is required, NHF can be used to pre-oxygenate patients either alone or in combination with non-invasive ventilation (NIV). Similarly, NHF reduces reintubation alone in low-risk patients and in combination with NIV in high-risk patients. NHF may be used in the emergency department in patients who would not be offered intubation and can be better tolerated than NIV.

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Acknowledgements

The authors thank Camille Le Breton for her support in drawing Figure n.3.

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Authors and Affiliations

  1. Medico-surgical ICU, Assistance Publique - Hôpitaux de Paris, DMU ESPRIT, Médecine Intensive Réanimation, Hôpital Louis Mourier, 92700, Colombes, France

    Jean-Damien Ricard

  2. Université de Paris, IAME, U1137, Inserm, 75018, Paris, France

    Jean-Damien Ricard

  3. Critical Care Department, Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain

    Oriol Roca

  4. Ciber Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain

    Oriol Roca

  5. Medical ICU Saint Louis Hospital, APHP, Paris, France

    Virginie Lemiale

  6. Critical Care Research Group, The Prince Charles Hospital, Chermside, Australia

    Amanda Corley

  7. University of Queensland, Brisbane, QLD, Australia

    Amanda Corley

  8. Department of Respiratory Medicine, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany

    Jens Braunlich

  9. Klinikum Emden, Bolardusstrasse 20, 26721, Emden, Germany

    Jens Braunlich

  10. School of Medicine, University of Auckland, Auckland, New Zealand

    Peter Jones

  11. Department of Emergency Medicine, Auckland City Hospital, Auckland, New Zealand

    Peter Jones

  12. Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea

    Byung Ju Kang

  13. Quebec Heart and Lung Institute, Laval University, Québec City, QC, Canada

    François Lellouche

  14. Department of Clinical, Integrated, and Experimental Medicine (DIMES), Respiratory and Critical Care, Sant’Orsola Malpighi Hospital, Bologna, Italy

    Stefano Nava

  15. Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Nuttapol Rittayamai

  16. Department of Respiratory Medicine, St James’s University Hospital, Leeds Teaching Hospital NHS Trust, Leeds, UK

    Giulia Spoletini

  17. Leeds Institute for Medical Research, University of Leeds, Leeds, UK

    Giulia Spoletini

  18. Saint Eloi ICU, Montpellier University Hospital and PhyMedExp, INSERM, CNRS, 34000, Montpellier, France

    Samir Jaber

  19. Intensive Care Medicine, University Hospital Virgen de la Salud, Toledo, Spain

    Gonzalo Hernandez

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  1. Jean-Damien Ricard
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Correspondence to Jean-Damien Ricard.

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Conflicts of interest

JDR received travel expenses and accommodation coverage from Fisher&Paykel Healthcare to attend scientific meetings. Fisher&Paykel Healthcare provided support for the ongoing High Flow ACRF trial (NCT03406572) but took no part in design or conduct of the study. OR received speaker fees from Air Liquide. His institution received consultancy fees from Hamilton Medical. VL has no conflict of interest to declare concerning this topic. JB received travel expenses, lecture fees and accommodation coverage from TNI medical AG and Fisher & Paykel Healthcare. TNI medical AG provided support for several NHF trials. AC’s employer, on her behalf, has received travel expenses, lecture fees and accommodation from Fisher & Paykel Healthcare to attend scientific meetings. Fisher & Paykel Healthcare has also provided an unrestricted grant to support investigator driven research, but has had no part in study design, conduct, analysis or reporting of the studies. PJ received competitive grant funding from the A + Trust (4926) and Greenlane Research and Education Fund (12/15/4086) for the HOTER RCT (ACTRN12610000960411) on HFNO in the ED. F&P Healthcare provided equipment for the HOTER RCT for which PJ was the principal investigator, but took no part in design, conduct, analysis or reporting of the study. PJ has no other personal financial or professional to declare. BJK: has no conflict of interest to declare. FL: Fisher&Paykel Healthcare provided support for the development of an application VentilO on optimization of protective mechanical ventilation. SN: Fisher&Paykel Healthcare provided support for the study # NCT03759457. NR received travel expenses and lecture fees from Fisher&Paykel Healthcare. GS: Fisher&Paykel Healthcare provided support for the study # NCT03965832 for which GS is the principal investigator. SJ received personal fees as consultant from Fisher-Paykel. GH received travel expenses coverage and lecture fees from Fisher&Paykel.

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Ricard, JD., Roca, O., Lemiale, V. et al. Use of nasal high flow oxygen during acute respiratory failure. Intensive Care Med 46, 2238–2247 (2020). https://doi.org/10.1007/s00134-020-06228-7

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