Intensive Care Medicine

, Volume 42, Issue 9, pp 1336–1349 | Cite as

Use of high-flow nasal cannula oxygenation in ICU adults: a narrative review

  • Laurent PapazianEmail author
  • Amanda Corley
  • Dean Hess
  • John F. Fraser
  • Jean-Pierre Frat
  • Christophe Guitton
  • Samir Jaber
  • Salvatore M. Maggiore
  • Stefano Nava
  • Jordi Rello
  • Jean-Damien Ricard
  • François Stephan
  • Rocco Trisolini
  • Elie Azoulay


Oxygen therapy can be delivered using low-flow, intermediate-flow (air entrainment mask), or high-flow devices. Low/intermediate-flow oxygen devices have several drawbacks that cause critically ill patients discomfort and translate into suboptimal clinical results. These include limitation of the FiO2 (due to the high inspiratory flow often observed in patients with respiratory failure), and insufficient humidification and warming of the inspired gas. High-flow nasal cannula oxygenation (HFNCO) delivers oxygen flow rates of up to 60 L/min and over the last decade its effect on clinical outcomes has widely been evaluated, such as in the improvement of respiratory distress, the need for intubation, and mortality. Mechanisms of action of HFNCO are complex and not limited to the increased oxygen flow rate. The main aim of this review is to guide clinicians towards evidence-based clinical practice guidelines. It summarizes current knowledge about HFNCO use in ICU patients and the potential areas of uncertainties. For instance, it has been recently suggested that HFNCO could improve the outcome of patients with hypoxemic acute respiratory failure. In other settings, research is ongoing and additional evidence is needed. For instance, if intubation is required, studies suggest that HFNCO may help to improve preoxygenation and can be used after extubation. Likewise, HFNCO might be used in obese patients, or to prevent respiratory deterioration in hypoxemic patients requiring bronchoscopy, or for the delivery of aerosol therapy. However, areas for which conclusive data exist are limited and interventions using standardized HFNCO protocols, comparators, and relevant clinical outcomes are warranted.


High-flow nasal cannula oxygenation Oxygen therapy Acute respiratory failure Bronchoscopy Aerosol Non-invasive ventilation 


Compliance with ethical standards

Conflicts of interest

Amanda Corley: unrestricted grant and travel expenses from Fisher and Paykel Healthcare; John F. Fraser: unrestricted grant and travel expenses from Fisher and Paykel Healthcare; Dean Hess: Philipps, Respironics, Bayer, Merck, Up To Date, McGraw-Hill, Jones and Bartlett, and the American Board of Internal Medicine; Jean-Damien Ricard: travel expenses from Fisher and Paykel Healthcare; Jean-Pierre Frat: travel expenses from Fisher and Paykel Healthcare; Stefano Nava: grant from Fisher and Paykel Healthcare; Salvatoire M. Maggiore: unrestricted research grant from Fisher and Paykel Healthcare; François Stephan: lecture fees from Fisher and Paykel Healthcare.

Financial support

No financial support.


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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2016

Authors and Affiliations

  • Laurent Papazian
    • 1
    • 2
    Email author
  • Amanda Corley
    • 3
  • Dean Hess
    • 4
  • John F. Fraser
    • 3
  • Jean-Pierre Frat
    • 5
    • 6
  • Christophe Guitton
    • 7
  • Samir Jaber
    • 8
  • Salvatore M. Maggiore
    • 9
  • Stefano Nava
    • 10
  • Jordi Rello
    • 11
  • Jean-Damien Ricard
    • 12
    • 13
    • 14
  • François Stephan
    • 15
  • Rocco Trisolini
    • 16
  • Elie Azoulay
    • 17
  1. 1.Réanimation des Détresses Respiratoires et Infections Sévères, Assistance Publique-Hôpitaux de MarseilleHôpital NordMarseilleFrance
  2. 2.URMITE UMR CNRS 7278, Faculté de MédecineAix-Marseille UniversitéMarseilleFrance
  3. 3.Critical Care Research GroupThe Prince Charles Hospital and University of QueenslandBrisbaneAustralia
  4. 4.Respiratory Care Department of the Massachusetts General Hospital and the Department of Anesthesia at the Harvard Medical SchoolBostonUSA
  5. 5.CHU de PoitiersRéanimation MédicalePoitiersFrance
  6. 6.INSERM, CIC-1402Université de PoitiersPoitiersFrance
  7. 7.Medical ICU, Hôtel-DieuUniversity Hospital of NantesNantesFrance
  8. 8.Department of Critical Care Medicine and Anesthesiology (DAR B), Research Unit INSERM U1046Saint Eloi University Hospital and Montpellier School of MedicineMontpellierFrance
  9. 9.Department of Anesthesiology and Critical Care Medicine, Policlinico SS. AnnunziataUniversità degli Studi “Gabriele d’Annunzio” Chieti-PescaraChietiItaly
  10. 10.Department of Specialist, Diagnostic and Experimental Medicine, School of Medicine, Respiratory and Critical Care, Sant’Orsola, Malpighi HospitalUniversità di BolognaBolognaItaly
  11. 11.Medicine Department, CIBERESUniversitat Autonoma de BarcelonaBarcelonaSpain
  12. 12.AP-HP, Hôpital Louis MourierService de Réanimation Médico-ChirurgicaleColombesFrance
  13. 13.INSERM, IAME, UMR 1137ParisFrance
  14. 14.IAME, UMR 1137, Sorbonne Paris CitéUniversité Paris DiderotParisFrance
  15. 15.Service de Réanimation adulteHôpital Marie LannelongueLe Plessis-RobinsonFrance
  16. 16.Interventional Pulmology, Sant’OrsolaMalpighi HospitalBolognaItaly
  17. 17.AP-HP, Hôpital Saint-Louis, Service de Réanimation Médicale, Sorbonne Paris CitéParis Diderot UniversityParisFrance

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