II. Definition

  1. Specially formulated device to deliver Body Temperature, humidified oxygen via a modified Nasal Cannula

III. Indications

  1. COPD exacerbation
    1. May bridge to BIPAP or intubation
  2. Endotracheal Intubation Preoxygenation
    1. Adjunct to allow longer safe intubation time (Apneic Oxygenation)
    2. Standard Nasal Cannula is often used in this case (at 15 L/min)
  3. Croup or Bronchiolitis
    1. Very effective with common use in pediatric intensive care
    2. Humidification of secretions likely contributes to benefit

IV. Mechanism

  1. High flow humidified oxygen delivered via nasal prongs (longer than with standard Nasal Cannula)
    1. Flow rates adjusted between 10-60 Liters/minute
    2. FIO2 titratable up to 100%
    3. Humidity and Temperature adjustable
  2. Oxygenates airway dead space
    1. In infants, airway dead space my be 12 ml, with Tidal Volume only 15 ml
    2. High flow nasal oxygen allows for oxygenation of this deadspace and passive oxygenation
  3. Provides CPAP-like positive pressure
    1. PEEP is generated by flow rates above the patient's typical Tidal Volume
    2. PEEP pressure estimated at 3 to 4 cm H2O (up to 7 cm H2O in some studies)
      1. Equivalent to pursed-lip breathing
    3. Decreases work of breathing by 15% while not modifying Tidal Volume
    4. May also decrease Nasal Airway obstruction (in infants and children)
    5. Patient should keep their mouth closed for benefit
      1. Patient can reduce the PEEP by opening their mouth
      2. Does not obstruct the mouth (patient can speak and eat)

V. Dosing

  1. Start with FIO2 of 100% and titrate down
  2. Patients should attempt to keep their mouth closed for maximal effect
  3. Flow rates
    1. Age <1 year: 2 L/kg/min or 8 L/min
    2. Age 1-12 years: 1 L/kg/min or 20 L/min
    3. Adults: 0.5 L/kg/min or 25-35 L/min (may use up to 40 L/min)

VI. References

  1. Mallemat and Swadron in Herbert (2013) EM:Rap 13(12): 10-11
  2. Sacchetti in Herbert (2014) EM:Rap 14(2): 9
  3. Sacchetti in Herbert (2018) EM:Rap 18(12): 13
  4. El-Khatib (2012) Respir Care 57(10): 1696-8 [PubMed]
  5. Ojha (2013) Acta Paediatr 102(3): 249-53 [PubMed]

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Ontology: High flow oxygen nasal cannula (C1960097)

Concepts Medical Device (T074)
SnomedCT 426854004
English High flow oxygen nasal cannula, High flow oxygen nasal cannula (physical object)
Spanish cánula nasal para elevado flujo de oxígeno (objeto físico), cánula nasal para elevado flujo de oxígeno