Table 1.
Problem | Pitfalls | Pearls |
---|---|---|
Starting HFNC therapy | Failure to assess the response and titrate therapy | The support is delivered by the flow and should be increased to the maximum flow if hypoxemia persists or work of breathing remains elevated Reassess frequently for signs of failure (e.g. persistent work of breathing, hypoxemia, a low ROX index) |
Using HFNC in the wrong patient | Using HFNC instead of bilevel noninvasive ventilation in COPD exacerbation with ventilatory failure | HFNC is a first-line therapy in acute hypoxemic respiratory failure; bilevel noninvasive ventilation is the treatment of choice in COPD exacerbation with acute hypercapnic respiratory failure; HFNC may be beneficial in acute hypercapnic respiratory failure, but the supporting evidence is limited |
Infection control | Aerosol generation and dispersion during HFNC are possible, particularly with symptomatic patients | Assuring well-fitting nasal prongs, applying a surgical mask over the cannula, and using lower flows when possible are simple measures to minimize risk |
Abbreviations: HFNC - high flow nasal cannula; COPD – chronic obstructive pulmonary disease; ROX index - ratio of pulse oximetry oxygen saturation over the fraction of inspired oxygen to the respiratory rate.