#Vapotherm high flow nasal cannula trial#

The authors reported no difference in intubation rates at 28 days with HFNO usage.

#Vapotherm high flow nasal cannula trial#

One of the significant recent studies was the FLORALI trial which compared intubation rates in 310 adult ICU patients with AHRF ( Table 1). Adult critically ill patients in the intensive care unit Therefore, HFNO settings that produce both optimal comfort and therapeutic effect vary with individual patients. However, it has been shown that higher temperature may negatively impact comfort regardless of flow rate and in more severe patients, higher flow rates may improve comfort ( 11). Moreover, HFNO may provide some advantages in terms of patients' comfort compared to NIPPV, and it is generally considered a well-tolerated device despite few studies having specifically addressed this aspect ( 10). These benefits led to recommendations for HFNO over NIPPV for treatment of AHRF by the American College of Physicians ( 8) and a strong recommendation with moderate certainty using GRADE guidelines for usage over COT during hypoxemic respiratory failure by a joint panel of experts within the European Society of Intensive Care Medicine ( 9). HFNO increases alveolar recruitment relative to conventional oxygen therapy (COT) without negatively affecting tidal volume ( 6) and improves oxygenation, inspiratory effort, respiratory rate (RR), lung volume, and other metrics compared to face masks ( 7). Non-invasive positive pressure ventilation (NIPPV) is associated with improved oxygenation but may cause lung damage through overdistention ( 6). Clinical efficacy of high flow nasal oxygenation Type I respiratory failure Adult patientsĪcute hypoxemic respiratory failure (AHRF) describes patients with inadequate tissue oxygenation associated with partial pressures of oxygen < 60 mmHG. For this review, an electronic literature search was conducted using PubMed and Google Scholar to summarize recent findings within key adult and pediatric patient populations. Mechanistically, HFNO has many beneficial characteristics, but clinical efficacy is debated. The physiological benefits of HFNO are well-described, including decreased work of breathing, improved tidal volumes, modest increases in positive end-expiratory pressure, enhanced mucociliary clearance of secretions, and accurate delivery of FiO 2 ( 2– 5). Whether these engineering differences have a measurable clinical impact remains a subject of study. This flush difference led to different FDA classifications (DEN170001). Flow levels are limited to 40 L/min, but the air has greater kinetic energy resulting in a larger flush at equivalent flow rates ( 1). The second category is high-velocity nasal insufflation (HVNI), which utilizes small-bore nasal cannulas to flush large airways, reducing anatomic dead space and increasing oxygen. Classic HFNO utilizes a high-flow nasal cannula providing heated, humidified air at flow rates up to 60 Liters/min with a corresponding fraction of inspired oxygen from 21 to 100%. Technological advancements have significantly augmented this concept creating a class of devices called “high flow nasal oxygen.” While there are a variety of HFNO machines available, they can broadly be divided into two groups. Historically, the term 'high-flow' referred to an increased bore size of the nasal cannula with associated gas flow. High flow nasal oxygen (HFNO) is a relatively new modality for treating patients with respiratory failure. Additionally, we discuss studies across clinical settings, including emergency departments, intensive care units, outpatient, and procedural settings.

In this article, we review the most recent findings on the clinical efficacy of high flow nasal oxygen in Type I, II, III, and IV respiratory failure within adult and pediatric patients. Despite well-described physiologic benefits, the clinical impact of high flow nasal oxygen is still under investigation. High flow nasal oxygen is a relatively new option for treating patients with respiratory failure, which decreases work of breathing, improves tidal volume, and modestly increases positive end expiratory pressure.

4Vapotherm, Inc., Exeter, NH, United States.

3Department of Emergency Medicine, University of Tennessee, Chattanooga, TN, United States.

2Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States.

1Scientific Consultant, Chattanooga, TN, United States.