Dataset Information

The role for high flow nasal cannula as a respiratory support strategy in adults: a clinical practice guideline.

ABSTRACT:

Purpose

High flow nasal cannula (HFNC) is a relatively recent respiratory support technique which delivers high flow, heated and humidified controlled concentration of oxygen via the nasal route. Recently, its use has increased for a variety of clinical indications. To guide clinical practice, we developed evidence-based recommendations regarding use of HFNC in various clinical settings.

Methods

We formed a guideline panel composed of clinicians, methodologists and experts in respiratory medicine. Using GRADE, the panel developed recommendations for four actionable questions.

Results

The guideline panel made a strong recommendation for HFNC in hypoxemic respiratory failure compared to conventional oxygen therapy (COT) (moderate certainty), a conditional recommendation for HFNC following extubation (moderate certainty), no recommendation regarding HFNC in the peri-intubation period (moderate certainty), and a conditional recommendation for postoperative HFNC in high risk and/or obese patients following cardiac or thoracic surgery (moderate certainty).

Conclusions

This clinical practice guideline synthesizes current best-evidence into four recommendations for HFNC use in patients with hypoxemic respiratory failure, following extubation, in the peri-intubation period, and postoperatively for bedside clinicians.

SUBMITTER: Rochwerg B

PROVIDER: S-EPMC7670292 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Publications

The role for high flow nasal cannula as a respiratory support strategy in adults: a clinical practice guideline.

Rochwerg Bram B Einav Sharon S Chaudhuri Dipayan D Mancebo Jordi J Mauri Tommaso T Helviz Yigal Y Goligher Ewan C EC Jaber Samir S Ricard Jean-Damien JD Rittayamai Nuttapol N Roca Oriol O Antonelli Massimo M Maggiore Salvatore Maurizio SM Demoule Alexandre A Hodgson Carol L CL Mercat Alain A Wilcox M Elizabeth ME Granton David D Wang Dominic D Azoulay Elie E Ouanes-Besbes Lamia L Cinnella Gilda G Rauseo Michela M Carvalho Carlos C Dessap-Mekontso Armand A Fraser John J Frat Jean-Pierre JP Gomersall Charles C Grasselli Giacomo G Hernandez Gonzalo G Jog Sameer S Pesenti Antonio A Riviello Elisabeth D ED Slutsky Arthur S AS Stapleton Renee D RD Talmor Daniel D Thille Arnaud W AW Brochard Laurent L Burns Karen E A KEA

Intensive care medicine 20201117 12

<h4>Purpose</h4>High flow nasal cannula (HFNC) is a relatively recent respiratory support technique which delivers high flow, heated and humidified controlled concentration of oxygen via the nasal route. Recently, its use has increased for a variety of clinical indications. To guide clinical practice, we developed evidence-based recommendations regarding use of HFNC in various clinical settings.<h4>Methods</h4>We formed a guideline panel composed of clinicians, methodologists and experts in resp ...[more]

PMID: 33201321

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Project description:BACKGROUND:Despite the extensive use of high-flow nasal cannula (HFNC) therapy in intensive care units (ICU) for acute respiratory failure (ARF), its daily clinical practice has not been assessed. We designed a regional survey in ICUs in North-west France to evaluate ICU physicians' clinical practice with HFNC. MATERIALS AND METHODS:We sent an observational survey to ICU physicians from 34 French ICUs over a 6-month period in 2016-2017. The survey included questions regarding the indications and expected efficiency of HFNC, practical aspects of use (initiation, weaning) and satisfaction. Comparisons between junior and senior ICU physicians were performed using a Fischer exact test. RESULTS:Among the 235 ICU physicians contacted, 137 responded (58.3%) all of whom regularly used HFNC. Hypoxemic ARF was considered a good indication for HFNC by all 137, but only 30% expected HFNC success (i.e., avoiding intubation in at least 60% of cases). Among hypoxemic indications, 30% of juniors considered acute pulmonary edema a good indication versus 74% of seniors (p < 0.0001). Hypercapnic ARF was considered a good indication by 33% with only 2% expecting HFNC success. A need for conventional oxygen therapy ≥ 6 L/min justified HFNC therapy for 40% and ≥ 9 L/min for 39% of responders. 58% of ICU physicians started HFNC therapy with a FiO2 ≥ 50% and 28% with a gas flow ≥ 50 L/min. Practices for HFNC weaning were heterogeneous: 48% considered a FiO2 ≤ 30%; whereas, 30% considered a FiO2 ≤ 30% with a high flow ≤ 20 L/min. Criteria for HFNC failure (i.e., need for intubation) were ventilatory pauses or arrest (97%), persistent hypoxemia (95%), respiratory acidosis (81%), worsening of breathing (95%, 100% of seniors and 86% of juniors, p = 0.003), bronchial congestion (75%) and circulatory failure (61%, 72% of seniors and 44% of juniors, p = 0.007). CONCLUSION:HFNC is used by ICU physicians in many situations of ARF, despite their relatively low expectations of success, especially in cases of hypercapnia. Clinical practices appear somewhat heterogeneous. Despite the physiological benefit of HFNC, further prospective observational studies are still required on HFNC outcomes and daily practices.

Dataset Information

The role for high flow nasal cannula as a respiratory support strategy in adults: a clinical practice guideline.

Purpose

Methods

Results

Conclusions

Publications

The role for high flow nasal cannula as a respiratory support strategy in adults: a clinical practice guideline.

Similar Datasets

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