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High Flow Nasal Cannula in Acute and Chronic Settings: Trends of Use and Outcomes

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Respiratory Medicine".

Deadline for manuscript submissions: closed (23 November 2023) | Viewed by 16964

Special Issue Editors

Dr. Claudia Crimi

E-Mail Website
Guest Editor
1. Respiratory Medicine Unit, Policlinico “G. Rodolico-San Marco” University Hospital, Via S. Sofia, 78, Catania, Italy
2. Department of Clinical and Experimental Medicine (MEDCLIN), University of Catania, Catania, Italy
Interests: noninvasive respiratory support techniques; acute and chronic respiratory failure; chronic respiratory disorders
Dr. Andrea Cortegiani

E-Mail Website
Guest Editor
Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, 90127 Palermo, Italy
Interests: intensive care; anaesthesiology; sepsis; infections; antimicrobial therapy
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

High flow nasal cannula is a relatively new type of noninvasive respiratory support that has been increasingly used in clinical practice over the last decade. Its several physiological benefits and the rationale for its application make it a particularly attractive technique that has been incorporated into daily practice in different clinical settings.

The available evidence supports the use of high flow nasal cannula for managing both acute and chronic respiratory failure in selected patients, and its use has been extended beyond intensive care and respiratory high dependency units to emergency departments, general wards, and outpatient clinics.

This Special Issue of JCM aims to collect the most recent findings in the area of high flow nasal cannula and will contribute significantly to stimulating the scientific debate, discussing clinical challenges and advancing the current body of knowledge of the medical community. This Special Issue will address unanswered questions on the application of high flow nasal therapy in both acute and chronic settings regarding:

  • Prevalence and current clinical practices;
  • Use in combination with other treatments or respiratory supports;
  • Timing of initiation;
  • Timing of discontinuation;
  • Criteria for treatment escalation or failure;
  • Factors associated with failure and success;
  • Monitoring;
  • Adherence and compliance to treatment;
  • Patient tolerance and comfort;
  • Clinically relevant outcomes and patient-oriented outcomes;
  • Aspects related to the device, oxygenation, humidification, tubing, nasal cannula, alarm.

Dr. Claudia Crimi
Dr. Andrea Cortegiani
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • high flow nasal cannula
  • acute hypoxemic respiratory failure
  • acute hypercapnic respiratory failure
  • chronic respiratory failure
  • acute settings
  • chronic settings

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Published Papers (7 papers)

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Editorial

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4 pages, 199 KiB  
Editorial
High-Flow Nasal Therapy in Acute and Chronic Respiratory Failure: Past, Present, and Future
by Claudia Crimi and Andrea Cortegiani
J. Clin. Med. 2023, 12(7), 2666; https://doi.org/10.3390/jcm12072666 - 3 Apr 2023
Cited by 6 | Viewed by 1875
Abstract
High-flow nasal therapy (HFNT) was introduced into clinical practice in the early 2000s as a form of noninvasive respiratory support (NIRS) [...] Full article
(This article belongs to the Special Issue High Flow Nasal Cannula in Acute and Chronic Settings: Trends of Use and Outcomes)

Research

Jump to: Editorial, Review

11 pages, 4023 KiB  
Article
Nasal High-Flow (NHF) Improves Ventilation in Patients with Interstitial Lung Disease (ILD)—A Physiological Study
by Jens Bräunlich, Marcus Köhler and Hubert Wirtz
J. Clin. Med. 2023, 12(18), 5853; https://doi.org/10.3390/jcm12185853 - 8 Sep 2023
Cited by 4 | Viewed by 1467
Abstract
Introduction: Acute hypercapnic respiratory failure has a poor prognosis in patients with interstitial lung disease (ILD). Recent data demonstrated a positive effect of nasal high-flow (NHF) in patients with acute hypoxemic respiratory failure. Preliminary data also show benefits in several hypercapnic chronic lung [...] Read more.
Introduction: Acute hypercapnic respiratory failure has a poor prognosis in patients with interstitial lung disease (ILD). Recent data demonstrated a positive effect of nasal high-flow (NHF) in patients with acute hypoxemic respiratory failure. Preliminary data also show benefits in several hypercapnic chronic lung diseases. Objectives: The aim of this study was to characterize flow-dependent changes in mean airway pressure, breathing volumes, and breathing frequency and decreases in PCO2. Methods: Mean airway pressure was measured in the nasopharyngeal space. To evaluate breathing volumes, a polysomnographic device was used (16 patients). All subjects received 20, 30, 40, and 50 L/min and—to illustrate the effects—nCPAP and nBiPAP. Capillary blood gas analyses were performed in 25 hypercapnic ILD subjects before and 5 h after the use of NHF. Additionally, comfort and dyspnea during the use of NHF were surveyed. Results: NHF resulted in a small flow-dependent increase in mean airway pressure. Tidal volume was unchanged and breathing rate decreased. The calculated minute volume decreased by 20 and 30 L/min NHF breathing. In spite of this fact, hypercapnia decreased at a flow rate of 24 L/min. Additionally, an improvement in dyspnea was observed. Conclusions: NHF leads to a reduction in paCO2. This is most likely achieved by a washout of the respiratory tract and a reduction in functional dead space. NHF enhances the effectiveness of breathing in ILD patients by the reduction in respiratory rate. In summary, NHF works as an effective ventilatory support device in hypercapnic ILD patients. Full article
(This article belongs to the Special Issue High Flow Nasal Cannula in Acute and Chronic Settings: Trends of Use and Outcomes)
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10 pages, 944 KiB  
Article
Effects of High-Flow Nasal Cannula on Right Heart Dysfunction in Patients with Acute-on-Chronic Respiratory Failure and Pulmonary Hypertension
by Corrado Pelaia, Giuseppe Armentaro, Chiara Lupia, Antonio Maiorano, Nicola Montenegro, Sofia Miceli, Valentino Condoleo, Velia Cassano, Andrea Bruni, Eugenio Garofalo, Claudia Crimi, Alessandro Vatrella, Girolamo Pelaia, Federico Longhini and Angela Sciacqua
J. Clin. Med. 2023, 12(17), 5472; https://doi.org/10.3390/jcm12175472 - 23 Aug 2023
Cited by 5 | Viewed by 2404
Abstract
High-flow nasal cannula (HFNC) has several benefits in patients affected by different forms of acute respiratory failure, based on its own mechanisms. We postulated that HFNC may have some advantages over conventional oxygen therapy (COT) on the heart function in patients with acute-on-chronic [...] Read more.
High-flow nasal cannula (HFNC) has several benefits in patients affected by different forms of acute respiratory failure, based on its own mechanisms. We postulated that HFNC may have some advantages over conventional oxygen therapy (COT) on the heart function in patients with acute-on-chronic respiratory failure with concomitant pulmonary hypertension (PH). We therefore designed this retrospective observational study to assess if HFNC improves the right and left ventricle functions and morphologies, arterial blood gases (ABGs), and patients’ dyspnea, compared to COT. We enrolled 17 hospitalized patients receiving HFNC, matched with 17 patients receiving COT. Echocardiographic evaluation was performed at the time of admission (baseline) and 10 days after (T10). HFNC showed significant improvements in right ventricular morphology and function, and a reduction in sPAP. However, there were no significant changes in the left heart measurements with HFNC application. Conversely, COT did not lead to any modifications in echocardiographic measurements. In both groups, oxygenation significantly improved from baseline to T10 (in the HFNC group, from 155 ± 47 to 204 ± 61 mmHg while in the COT group, from 157 ± 27 to 207 ± 27 mmHg; p < 0.0001 for both comparisons). In conclusion, these data suggest an improvement of oxygenation with both treatments; however, only HFNC was able to improve the right ventricular morphology and function after 10 days from the beginning of treatment in a small cohort of patients with acute-on-chronic respiratory failure with PH. Full article
(This article belongs to the Special Issue High Flow Nasal Cannula in Acute and Chronic Settings: Trends of Use and Outcomes)
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11 pages, 1534 KiB  
Article
A Real-Life Study of Combined Treatment with Long-Term Non-Invasive Ventilation and High Flow Nasal Cannula in Patients with End-Stage Chronic Obstructive Lung Disease
by Ulla Møller Weinreich and Line Hust Storgaard
J. Clin. Med. 2023, 12(13), 4485; https://doi.org/10.3390/jcm12134485 - 4 Jul 2023
Cited by 4 | Viewed by 2468
Abstract
Patients with end-stage chronic obstructive pulmonary disease (COPD) often develop persistent hypoxic or hypercapnic respiratory failure, or a combination of both. Ventilatory support, in terms of a long-term high-flow nasal cannula (LT-HFNC) and long-term non-invasive ventilation (LT-NIV), may be indicated. Often, clinicians choose [...] Read more.
Patients with end-stage chronic obstructive pulmonary disease (COPD) often develop persistent hypoxic or hypercapnic respiratory failure, or a combination of both. Ventilatory support, in terms of a long-term high-flow nasal cannula (LT-HFNC) and long-term non-invasive ventilation (LT-NIV), may be indicated. Often, clinicians choose either one or the other. This paper explores combined treatment with LT-HFNC and LT-NIV in a real-life setting. In total, 33 patients with COPD and persistent respiratory failure were included in this study. Of those, 17 were initiated on LT-HFNC and used it for 595 (374) days and 16 were initiated on LT-NIV and used it for 558 (479) days. On average, patients used respiratory support continuously for 908 (586) days. Baseline characteristics were comparable, apart from PaCO2 at first ventilatory support initiation (LT-HFNC/LT-NIV 7.1 (1.1) kPa/8.8 (0.9) kPa respectively (p = 0.002)). Both groups experienced a reduction in hospitalizations in the first twelve months after treatment initiation, compared to the twelve months before (LT-HFNC p = 0.022 and LT-NIV p = 0.014). In total, 25% of LT-NIV patients stopped treatment after HFNC initiation due to intolerance and 59% stopped LT-HFNC treatment 126 (36) days after LT-NIV initiation as monotherapy was sufficient. In 44% of these patients, LT-HFNC was re-initiated at the end of life. At the time of analysis, 70% of patients had died. In the last three months of life, patients stopped using LT-NIV, whereas 91% used LT-HFNC. In conclusion, the combined use of LT-NIV and LT-HFNC reduced hospitalizations in patients with COPD and persistent respiratory failure. The study indicates that LT-HFNC is well tolerated, and better tolerated than LT-NIV at the very end stages of COPD. Full article
(This article belongs to the Special Issue High Flow Nasal Cannula in Acute and Chronic Settings: Trends of Use and Outcomes)
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13 pages, 576 KiB  
Communication
International Survey of High-Flow Nasal Therapy Use for Respiratory Failure in Adult Patients
by Asem Alnajada, Bronagh Blackwood, Ben Messer, Ivan Pavlov and Murali Shyamsundar
J. Clin. Med. 2023, 12(12), 3911; https://doi.org/10.3390/jcm12123911 - 8 Jun 2023
Cited by 3 | Viewed by 2786
Abstract
(1) Background: High-flow nasal therapy (HFNT) has shown several benefits in addressing respiratory failure. However, the quality of evidence and the guidance for safe practice are lacking. This survey aimed to understand HFNT practice and the needs of the clinical community to support [...] Read more.
(1) Background: High-flow nasal therapy (HFNT) has shown several benefits in addressing respiratory failure. However, the quality of evidence and the guidance for safe practice are lacking. This survey aimed to understand HFNT practice and the needs of the clinical community to support safe practice. (2) Method: A survey questionnaire was developed and distributed to relevant healthcare professionals through national networks in the UK, USA and Canada; responses were collected between October 2020 and April 2021. (3) Results: In the UK and Canada, HFNT was used in 95% of hospitals, with the highest use being in the emergency department. HNFT was widely used outside of a critical care setting. HFNT was mostly used to treat acute type 1 respiratory failure (98%), followed by acute type 2 respiratory failure and chronic respiratory failure. Guideline development was felt to be important (96%) and urgent (81%). Auditing of practice was lacking in 71% of hospitals. In the USA, HFNT was broadly similar to UK and Canadian practice. (4) Conclusions: The survey results reveal several key points: (a) HFNT is used in clinical conditions with limited evidence; (b) there is a lack of auditing; (c) it is used in wards that may not have the appropriate skill mix; and (d) there is a lack of guidance for HFNT use. Full article
(This article belongs to the Special Issue High Flow Nasal Cannula in Acute and Chronic Settings: Trends of Use and Outcomes)
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Review

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11 pages, 605 KiB  
Review
The Role of High-Flow Nasal Cannula Oxygen Therapy in Exercise Testing and Pulmonary Rehabilitation: A Review of the Current Literature
by Claudio Candia, Carmen Lombardi, Claudia Merola, Pasquale Ambrosino, Silvestro Ennio D’Anna, Aldo Vicario, Stefania De Marco, Antonio Molino and Mauro Maniscalco
J. Clin. Med. 2024, 13(1), 232; https://doi.org/10.3390/jcm13010232 - 30 Dec 2023
Cited by 4 | Viewed by 3112
Abstract
High-flow nasal cannula (HFNC) has recently emerged as a crucial therapeutic strategy for hypoxemic patients both in acute and chronic settings. Indeed, HFNC therapy is able to deliver higher fractions of inspired oxygen (FiO2) with a heated and humidified gas flow [...] Read more.
High-flow nasal cannula (HFNC) has recently emerged as a crucial therapeutic strategy for hypoxemic patients both in acute and chronic settings. Indeed, HFNC therapy is able to deliver higher fractions of inspired oxygen (FiO2) with a heated and humidified gas flow ranging from 20 up to 60 L per minute, in a more comfortable way for the patient in comparison with Conventional Oxygen Therapy (COT). In fact, the flow keeps the epithelium of the airways adequately moisturized, thus positively affecting the mucus clearance. Finally, the flow is able to wash out the carbon dioxide in the dead space of the airways; this is also enhanced by a modest positive end-expiratory pressure (PEEP) effect. Recent evidence has shown applications of HFNC in exercise training and chronic settings with promising results. In this narrative review, we explored how HFNC might contribute to enhancing outcomes of exercise training and pulmonary rehabilitation among patients dealing with chronic obstructive pulmonary disease, interstitial lung diseases, and lung cancer. Full article
(This article belongs to the Special Issue High Flow Nasal Cannula in Acute and Chronic Settings: Trends of Use and Outcomes)
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11 pages, 550 KiB  
Review
High-Flow Nasal Cannula Therapy as an Adjuvant Therapy for Respiratory Support during Endoscopic Techniques: A Narrative Review
by Marta Corral-Blanco, Javier Sayas-Catalán, Ana Hernández-Voth, Laura Rey-Terrón and Victoria Villena-Garrido
J. Clin. Med. 2024, 13(1), 81; https://doi.org/10.3390/jcm13010081 - 22 Dec 2023
Cited by 2 | Viewed by 1705
Abstract
High-flow nasal cannula (HFNC) is a respiratory support technique that delivers a controlled concentration of oxygen with high flow, heat, and humidity via the nasal pathway. As it has many physiological effects, its use has increased for a variety of clinical indications; however, [...] Read more.
High-flow nasal cannula (HFNC) is a respiratory support technique that delivers a controlled concentration of oxygen with high flow, heat, and humidity via the nasal pathway. As it has many physiological effects, its use has increased for a variety of clinical indications; however, there is limited guidance on using HFNC as a respiratory support tool during endoscopic procedures. We conducted a narrative review to evaluate the effect of HFNC as an adjuvant tool during fiberoptic bronchoscopy (FOB), upper gastrointestinal tract endoscopy, and surgical procedures in adults. A search of the PubMed and Cochrane databases were performed. Approximately 384 publications were retrieved, and 99 were selected (93 original works and 6 case reports with a literature review). In patients who underwent FOB, HFNC appears to be superior to conventional oxygen therapy (COT) in preventing hypoxaemia. In contrast, for gastrointestinal endoscopy, the current evidence is insufficient to recommend HFNC over COT in a cost-effective manner. Finally, in surgical procedures such as laryngeal microsurgery or thoracic surgery, HFNC has been shown to be a safe and effective alternative to orotracheal intubation. As the results are heterogeneous, we advocate for the need for more quality studies to understand the effectiveness of HFNC during endoscopic procedures. Full article
(This article belongs to the Special Issue High Flow Nasal Cannula in Acute and Chronic Settings: Trends of Use and Outcomes)
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