A Systematic Review of the High-flow Nasal Cannula for Adult Patients

  • Y. Helviz
  • S. EinavEmail author
Part of the Annual Update in Intensive Care and Emergency Medicine book series (AUICEM)


Awareness of the potential damage associated with the use of invasive ventilation (e.g., ventilator‐associated pneumonia [VAP], excessive pulmonary stress and strain) and increasing sophistication in patient‐ventilator interfaces have led to development of several interesting new modes of delivering non‐invasive ventilation (NIV), not least of which is the high‐flow nasal cannula (HFNC).

The HFNC was first developed for use in neonates. Although many adult patients found the use of a close‐fitting mask not particularly tolerable, the most common issue in the adult population usually remained clearance of airway secretions [1]. In the neonatal population however, severe pressure sores became a major concern with the use of a tight face mask [2]. The HFNC was thus originally developed with the intention of maintaining the benefit of high oxygen flows (and thus the increased end-expiratory pulmonary pressures) without compromising blood flow to skin areas susceptible...


  1. 1.
    Ozyilmaz E, Ugurlu AO, Nava S (2014) Timing of noninvasive ventilation failure: causes, risk factors, and potential remedies. BMC Pulm Med 14:19CrossRefGoogle Scholar
  2. 2.
    Shoemaker M, Pierce M, Yoder B, DiGeronimo R (2007) High flow nasal cannula versus nasal CPAP for neonatal respiratory disease: a retrospective study. J Perinatol 27:85–91CrossRefGoogle Scholar
  3. 3.
    Ward JJ (2013) High-flow oxygen administration by nasal cannula for adult and perinatal patients. Respir Care 58:98–122CrossRefGoogle Scholar
  4. 4.
    Nishimura M (2016) High-flow nasal cannula oxygen therapy in adults. J Intensive Care 3:15CrossRefGoogle Scholar
  5. 5.
    Parke RL, Eccleston ML, McGuinness SP (2011) The effects of flow on airway pressure during nasal high-flow oxygen therapy. Respir Care 56:1151–1155CrossRefGoogle Scholar
  6. 6.
    Groves N, Tobin A (2007) High flow nasal oxygen generates positive airway pressure in adult volunteers. Aust Crit Care 20:126–131CrossRefGoogle Scholar
  7. 7.
    Frizzola M, Miller TL, Rodriguez ME et al (2011) High-flow nasal cannula: Impact on oxygenation and ventilation in an acute lung injury model. Pediatr Pulmonol 46:67–74CrossRefGoogle Scholar
  8. 8.
    Hasani A, Chapman T, McCool D et al (2008) Domiciliary humidification improves lung mucociliary clearance in patients with bronchiectasis. Chron Respir Dis 5:81–86CrossRefGoogle Scholar
  9. 9.
    Sztrymf B, Messika J, Bertrand F et al (2011) Beneficial effects of humidified high flow nasal oxygen in critical care patients: a prospective pilot study. Intensive Care Med 37:1780–1786CrossRefGoogle Scholar
  10. 10.
    Itagaki T, Okuda N, Tsunano Y et al (2014) Effect of high-flow nasal cannula on thoraco-abdominal synchrony in adult critically ill patients. Respir Care 59:70–74CrossRefGoogle Scholar
  11. 11.
    Corley A, Caruana LR, Barnett AG et al (2011) Oxygen delivery through high-flow nasal cannulae increase end-expiratory lung volume and reduce respiratory rate in post-cardiac surgical patients. Br J Anaesth 107:998–1004CrossRefGoogle Scholar
  12. 12.
    Esteban A, Frutos-Vivar F, Ferguson ND et al (2004) Noninvasive positive-pressure ventilation for respiratory failure after extubation. N Engl J Med 350:2452–2460CrossRefGoogle Scholar
  13. 13.
    Kang BJ, Koh Y, Lim C-M et al (2015) Failure of high-flow nasal cannula therapy may delay intubation and increase mortality. Intensive Care Med 41:623–632CrossRefGoogle Scholar
  14. 14.
    Rello J, Pérez M, Roca O et al (2012) High-flow nasal therapy in adults with severe acute respiratory infection. J Crit Care 27:434–439CrossRefGoogle Scholar
  15. 15.
    Frat JP, Thille AW, Mercat A et al (2015) High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med 372:2185–2196CrossRefGoogle Scholar
  16. 16.
    Belley-Côté EP, Duceppe E, Whitlock RP (2015) High-flow nasal cannula oxygen in respiratory failure. N Engl J Med 373:1373CrossRefGoogle Scholar
  17. 17.
    Wawrzeniak IC, Moraes RB, Fendt LCC (2015) High-flow nasal cannula oxygen in respiratory failure. N Engl J Med 373:1373CrossRefGoogle Scholar
  18. 18.
    Sehgal IS, Dhooria S, Agarwal R (2015) High-flow nasal cannula oxygen in respiratory failure. N Engl J Med 373:1374PubMedGoogle Scholar
  19. 19.
    Frat JP, Ragot S, Thille AW (2015) High-flow nasal cannula oxygen in respiratory failure. N Engl J Med 373:1373–1375CrossRefGoogle Scholar
  20. 20.
    Ou X, Hua Y, Liu J et al (2017) Effect of high-flow nasal cannula oxygen therapy in adults with acute hypoxemic respiratory failure: a meta-analysis of randomized controlled trials. CMAJ 189:E260–E267CrossRefGoogle Scholar
  21. 21.
    Monro-Somerville T, Sim M, Ruddy J et al (2017) The effect of high-flow nasal cannula oxygen therapy on mortality and intubation rate in acute respiratory failure. Crit Care Med 45:e449–e456CrossRefGoogle Scholar
  22. 22.
    Roca O, Pérez-Terán P, Masclans JR et al (2013) Patients with New York Heart Association class III heart failure may benefit with high flow nasal cannula supportive therapy: high flow nasal cannula in heart failure. J Crit Care 28:741–746CrossRefGoogle Scholar
  23. 23.
    Esquinas AM, Papadakos PJ (2014) High-flow nasal cannula supportive therapy in chronic heart failure: a partial or completed “CPAP-like effect”? J Crit Care 29:465CrossRefGoogle Scholar
  24. 24.
    Krinsley JS, Reddy PK, Iqbal A (2012) What is the optimal rate of failed extubation? Crit Care 16:111CrossRefGoogle Scholar
  25. 25.
    Kulkarni AP, Agarwal V (2008) Extubation failure in intensive care unit: predictors and management. Indian J Crit Care Med 12:1–9CrossRefGoogle Scholar
  26. 26.
    Stéphan F, Barrucand B, Petit P et al (2015) High-flow nasal oxygen vs noninvasive positive airway pressure in hypoxemic patients after cardiothoracic surgery. JAMA 313:2331CrossRefGoogle Scholar
  27. 27.
    Parke R, McGuinness S, Dixon R, Jull A (2013) Open-label, phase II study of routine high-flow nasal oxygen therapy in cardiac surgical patients. Br J Anaesth 111:925–931CrossRefGoogle Scholar
  28. 28.
    Corley A, Bull T, Spooner AJ et al (2015) Direct extubation onto high-flow nasal cannulae post-cardiac surgery versus standard treatment in patients with a BMI≥30: a randomised controlled trial. Intensive Care Med 41:887–894CrossRefGoogle Scholar
  29. 29.
    Zhu Y, Yin H, Zhang R, Wei J (2017) High-flow nasal cannula oxygen therapy vs conventional oxygen therapy in cardiac surgical patients: a meta-analysis. J Crit Care 38:123–128CrossRefGoogle Scholar
  30. 30.
    Futier E, Paugam-Burtz C, Godet T et al (2016) Effect of early postextubation high-flow nasal cannula vs conventional oxygen therapy on hypoxaemia in patients after major abdominal surgery: a French multicentre randomised controlled trial (OPERA). Intensive Care Med 42:1888–1898CrossRefGoogle Scholar
  31. 31.
    Maggiore SM, Idone FA, Vaschetto R et al (2014) Nasal high-flow versus venturi mask oxygen therapy after extubation. Effects on oxygenation, comfort, and clinical outcome. Am J Respir Crit Care Med 190:282–288CrossRefGoogle Scholar
  32. 32.
    Hernández G, Vaquero C, Colinas L et al (2016) Effect of postextubation high-flow nasal cannula vs noninvasive ventilation on reintubation and postextubation respiratory failure in high-risk patients. JAMA 316:1565CrossRefGoogle Scholar
  33. 33.
    Hernández G, Vaquero C, González P et al (2016) Effect of postextubation high-flow nasal cannula vs conventional oxygen therapy on reintubation in low-risk patients. JAMA 315:1354CrossRefGoogle Scholar
  34. 34.
    Simon M, Braune S, Frings D et al (2014) High-flow nasal cannula oxygen versus non-invasive ventilation in patients with acute hypoxaemic respiratory failure undergoing flexible bronchoscopy - a prospective randomised trial. Crit Care 18:712CrossRefGoogle Scholar
  35. 35.
    Lucangelo U, Vassallo FG, Marras E et al (2012) High-flow nasal interface improves oxygenation in patients undergoing bronchoscopy. Crit Care Res Pract 2012:506382PubMedPubMedCentralGoogle Scholar
  36. 36.
    Neilipovitz DT, Crosby ET (2007) No evidence for decreased incidence of aspiration after rapid sequence induction. Can J Anesth 54:748–764CrossRefGoogle Scholar
  37. 37.
    Vourc’h M, Asfar P, Volteau C et al (2015) High-flow nasal cannula oxygen during endotracheal intubation in hypoxemic patients: a randomized controlled clinical trial. Intensive Care Med 41:1538–1548CrossRefGoogle Scholar
  38. 38.
    Jaber S, Monnin M, Girard M et al (2016) Apnoeic oxygenation via high-flow nasal cannula oxygen combined with non-invasive ventilation preoxygenation for intubation in hypoxaemic patients in the intensive care unit: the single-centre, blinded, randomised controlled OPTINIV trial. Intensive Care Med 42:1877–1887CrossRefGoogle Scholar
  39. 39.
    Simon M, Wachs C, Braune S et al (2016) High-flow nasal cannula versus bag-valve-mask for preoxygenation before intubation in subjects with hypoxemic respiratory failure. Respir Care 61:1160–1167CrossRefGoogle Scholar
  40. 40.
    Heinrich S, Horbach T, Stubner B et al (2014) Benefits of heated and humidified high flow nasal oxygen for preoxygenation in morbidly obese patients undergoing bariatric surgery: a randomized controlled study. J Obes Bariatrics 1:1–7Google Scholar
  41. 41.
    Azoulay E, Lemiale V, Mokart D et al (2014) Acute respiratory distress syndrome in patients with malignancies. Intensive Care Med 40:1106–1114CrossRefGoogle Scholar
  42. 42.
    Ewig S, Torres A, Riquelme R et al (1998) Pulmonary complications in patients with haematological malignancies treated at a respiratory ICU. Eur Respir J 12:116–122CrossRefGoogle Scholar
  43. 43.
    Coudroy R, Jamet A, Petua P et al (2016) High-flow nasal cannula oxygen therapy versus noninvasive ventilation in immunocompromised patients with acute respiratory failure: an observational cohort study. Ann Intensive Care 6:45CrossRefGoogle Scholar
  44. 44.
    Lee HY, Rhee CK, Lee JW (2015) Feasibility of high-flow nasal cannula oxygen therapy for acute respiratory failure in patients with hematologic malignancies: a retrospective single-center study. J Crit Care 30:773–777CrossRefGoogle Scholar
  45. 45.
    Harada K, Kurosawa S, Hino Y et al (2016) Clinical utility of high-flow nasal cannula oxygen therapy for acute respiratory failure in patients with hematological disease. Springerplus 5:512CrossRefGoogle Scholar
  46. 46.
    Booth S, Anderson H, Swannick M et al (2004) The use of oxygen in the palliation of breathlessness. A report of the expert working group of the scientific committee of the association of palliative medicine. Respir Med 98:66–77CrossRefGoogle Scholar
  47. 47.
    Epstein AS, Hartridge-Lambert SK, Ramaker JS et al (2011) Humidified high-flow nasal oxygen utilization in patients with cancer at Memorial Sloan-Kettering Cancer Center. J Palliat Med 14:835–839CrossRefGoogle Scholar
  48. 48.
    Peters SG, Holets SR, Gay PC (2013) High-flow nasal cannula therapy in do-not-intubate patients with hypoxemic respiratory distress. Respir Care 58:597–600PubMedGoogle Scholar
  49. 49.
    Fealy N, Osborne C, Eastwood GM et al (2016) Nasal high-flow oxygen therapy in ICU: a before-and-after study. Aust Crit Care 29:17–22CrossRefGoogle Scholar
  50. 50.
    Rabbat A, Blanc K, Lefebvre A, Lorut C (2016) Nasal high flow oxygen therapy after extubation: the road is open but don’t drive too fast! J Thorac Dis 8:E1620–E1624CrossRefGoogle Scholar
  51. 51.
    Ni YN, Luo J, Yu H et al (2017) Can high-flow nasal cannula reduce the rate of endotracheal intubation in adult patients with acute respiratory failure compared with conventional oxygen therapy and noninvasive positive pressure ventilation?: a systematic review and meta-analysis. Chest 151:764–775CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.The Intensive Care Unit of the Shaare Zedek Medical CentreJerusalemIsrael
  2. 2.The Faculty of Medicine of the Hebrew UniversityJerusalemIsrael

Personalised recommendations