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

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

doi:10.1007/s00134-020-06312-y

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

Bram Rochwerg
, Sharon Einav
, Dipayan Chaudhuri
, Jordi Mancebo
, Tommaso Mauri
, Yigal Helviz
, Ewan C. Goligher
, Samir Jaber
, Jean Damien Ricard
, Nuttapol Rittayamai
, Oriol Roca
, Massimo Antonelli
, Salvatore Maurizio Maggiore
, Alexandre Demoule
, Carol L. Hodgson
, Alain Mercat
, M. Elizabeth Wilcox
, David Granton
, Dominic Wang
, Elie Azoulay

Lamia Ouanes-Besbes, Gilda Cinnella, Michela Rauseo, Carlos Carvalho, Armand Dessap-Mekontso, John Fraser, Jean Pierre Frat, Charles Gomersall, Giacomo Grasselli, Gonzalo Hernandez, Sameer Jog, Antonio Pesenti, Elisabeth D. Riviello, Arthur S. Slutsky, Renee D. Stapleton, Daniel Talmor, Arnaud W. Thille, Laurent Brochard, Karen E.A. Burns

Department of Medicine

McMaster University
Shaare Zedek Med Ctr
The Hebrew University of Jerusalem
Hospital Universitari Sant Pau
University of Milan
University Health Network University of Toronto
University of Toronto
University Hospital of Montpellier and Saint Eloi Hospital
Hôpital Louis Mourier
Universite Paris Cite
Vall d'Hebron research Institute-UAB/Neurodegenerative Diseases Group
Instituto de Salud Carlos III
Fondazione Policlinico Universitario A Gemelli IRCCS
Università Cattolica Del Sacro Cuore
University “G. D'Annunzio”
Sorbonne Université
AP-HP Assistance Publique - Hopitaux de Paris
Monash University
Université d’Angers
Hospital Fattouma Bourguina
Cardiopulmonary Research in Intensive Care and Toxicology
Università degli Studi di Foggia
University of São Paulo
Hôpital Henri Mondor
Faculté de Santé
University of Queensland
Prince Charles Hosp
Université de Poitiers
Chinese University of Hong Kong
University Hospital Virgen de La Salud
Deenanath Mangeshkar Hospital and Research Center, Pune
Harvard Medical School
Keenan Research Centre for Biomedical Science
St. Michael's Hospital
University of Vermont Larner College of Medicine
University Hospital of Poitiers

Research output: Contribution to journal › Article › peer-review

328 Citations (Scopus)

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.

Original language	English
Pages (from-to)	2226-2237
Number of pages	12
Journal	Intensive Care Medicine
Volume	46
Issue number	12
DOIs	https://doi.org/10.1007/s00134-020-06312-y
Publication status	Published - Dec 2020

Keywords

Extubation
High flow nasal cannula
Mortality
Peri-intubation
Postoperative
Respiratory failure

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10.1007/s00134-020-06312-y

Cite this

Rochwerg, B., Einav, S., Chaudhuri, D., Mancebo, J., Mauri, T., Helviz, Y., Goligher, E. C., Jaber, S., Ricard, J. D., Rittayamai, N., Roca, O., Antonelli, M., Maggiore, S. M., Demoule, A., Hodgson, C. L., Mercat, A., Wilcox, M. E., Granton, D., Wang, D., ... Burns, K. E. A. (2020). The role for high flow nasal cannula as a respiratory support strategy in adults: a clinical practice guideline. Intensive Care Medicine, 46(12), 2226-2237. https://doi.org/10.1007/s00134-020-06312-y

@article{d21caf925a114199b2f4cc05e24c8752,

title = "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.",

keywords = "Extubation, High flow nasal cannula, Mortality, Peri-intubation, Postoperative, Respiratory failure",

author = "Bram Rochwerg and Sharon Einav and Dipayan Chaudhuri and Jordi Mancebo and Tommaso Mauri and Yigal Helviz and Goligher, \{Ewan C.\} and Samir Jaber and Ricard, \{Jean Damien\} and Nuttapol Rittayamai and Oriol Roca and Massimo Antonelli and Maggiore, \{Salvatore Maurizio\} and Alexandre Demoule and Hodgson, \{Carol L.\} and Alain Mercat and Wilcox, \{M. Elizabeth\} and David Granton and Dominic Wang and Elie Azoulay and Lamia Ouanes-Besbes and Gilda Cinnella and Michela Rauseo and Carlos Carvalho and Armand Dessap-Mekontso and John Fraser and Frat, \{Jean Pierre\} and Charles Gomersall and Giacomo Grasselli and Gonzalo Hernandez and Sameer Jog and Antonio Pesenti and Riviello, \{Elisabeth D.\} and Slutsky, \{Arthur S.\} and Stapleton, \{Renee D.\} and Daniel Talmor and Thille, \{Arnaud W.\} and Laurent Brochard and Burns, \{Karen E.A.\}",

note = "Publisher Copyright: {\textcopyright} 2020, Springer-Verlag GmbH Germany, part of Springer Nature.",

year = "2020",

month = dec,

doi = "10.1007/s00134-020-06312-y",

language = "English",

volume = "46",

pages = "2226--2237",

journal = "Intensive Care Medicine",

issn = "0342-4642",

publisher = "Springer Science and Business Media Deutschland GmbH",

number = "12",

}

Rochwerg, B, Einav, S, Chaudhuri, D, Mancebo, J, Mauri, T, Helviz, Y, Goligher, EC, Jaber, S, Ricard, JD, Rittayamai, N, Roca, O, Antonelli, M, Maggiore, SM, Demoule, A, Hodgson, CL, Mercat, A, Wilcox, ME, Granton, D, Wang, D, Azoulay, E, Ouanes-Besbes, L, Cinnella, G, Rauseo, M, Carvalho, C, Dessap-Mekontso, A, Fraser, J, Frat, JP, Gomersall, C, Grasselli, G, Hernandez, G, Jog, S, Pesenti, A, Riviello, ED, Slutsky, AS, Stapleton, RD, Talmor, D, Thille, AW, Brochard, L & Burns, KEA 2020, 'The role for high flow nasal cannula as a respiratory support strategy in adults: a clinical practice guideline', Intensive Care Medicine, vol. 46, no. 12, pp. 2226-2237. https://doi.org/10.1007/s00134-020-06312-y

TY - JOUR

T1 - The role for high flow nasal cannula as a respiratory support strategy in adults

T2 - a clinical practice guideline

AU - Rochwerg, Bram

AU - Einav, Sharon

AU - Chaudhuri, Dipayan

AU - Mancebo, Jordi

AU - Mauri, Tommaso

AU - Helviz, Yigal

AU - Goligher, Ewan C.

AU - Jaber, Samir

AU - Ricard, Jean Damien

AU - Rittayamai, Nuttapol

AU - Roca, Oriol

AU - Antonelli, Massimo

AU - Maggiore, Salvatore Maurizio

AU - Demoule, Alexandre

AU - Hodgson, Carol L.

AU - Mercat, Alain

AU - Wilcox, M. Elizabeth

AU - Granton, David

AU - Wang, Dominic

AU - Azoulay, Elie

AU - Ouanes-Besbes, Lamia

AU - Cinnella, Gilda

AU - Rauseo, Michela

AU - Carvalho, Carlos

AU - Dessap-Mekontso, Armand

AU - Fraser, John

AU - Frat, Jean Pierre

AU - Gomersall, Charles

AU - Grasselli, Giacomo

AU - Hernandez, Gonzalo

AU - Jog, Sameer

AU - Pesenti, Antonio

AU - Riviello, Elisabeth D.

AU - Slutsky, Arthur S.

AU - Stapleton, Renee D.

AU - Talmor, Daniel

AU - Thille, Arnaud W.

AU - Brochard, Laurent

AU - Burns, Karen E.A.

PY - 2020/12

Y1 - 2020/12

N2 - 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.

AB - 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.

KW - Extubation

KW - High flow nasal cannula

KW - Mortality

KW - Peri-intubation

KW - Postoperative

KW - Respiratory failure

UR - https://www.scopus.com/pages/publications/85096111314

U2 - 10.1007/s00134-020-06312-y

DO - 10.1007/s00134-020-06312-y

M3 - Article

C2 - 33201321

AN - SCOPUS:85096111314

SN - 0342-4642

VL - 46

SP - 2226

EP - 2237

JO - Intensive Care Medicine

JF - Intensive Care Medicine

IS - 12

ER -

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

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Keywords

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