High Flow Nasal Cannula

What is it?

• High flow nasal cannula has been used in pediatrics for some time now
• It can be used in adults as well
• It is a simple nasal cannula setup with larger cannula sizes in both nares
• It is heated, humidified oxygen
• You can control your oxygen level and flow of oxygen

Benefits

• Small amount of PEEP provided to the patient (estimated 5-7 cm H20)
• Improves oxygenation (more reliable oxygenation than a non-rebreather face mask)
• Can provide some alveolar recruitment
• Increases FRC (functional residual capacity)
• Pharyngeal dead space washout

Who to use it on

• Acute hypoxemic respiratory failure
• Pre-intubation (can place before and during intubation in patients who have low oxygen saturation)
• Post-extubation
• Palliative care (DNI patients)

How to set it

• Flow rates: 0-60 L/min
• Spontaneously breathing patient with mild-moderate hypoxemia/respiratory distress:

            -15-30 L per minute

            -100% oxygen (wean as tolerated)

            -temp 35-40 C

            -when weaning decrease oxygen prior to flow

Bottom line: No evidence that it reduces intubation rates in patients with hypoxemic respiratory failure but may improve oxygenation issues while deciding on treatment options

References