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

2020; Springer Science+Business Media; Volume: 46; Issue: 12 Linguagem: Inglês

10.1007/s00134-020-06312-y

1432-1238

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 Hodgson, Alain Mercat, M. Elizabeth Wilcox, David Granton, Dominic Wang, Élie Azoulay, Lamia Ouanes-Besbes, Gilda Cinnella, Michela Rauseo, Carlos Roberto Ribeiro de Carvalho, Armand Dessap-Mekontso, John F. Fraser, Jean‐Pierre Frat, Charles D. Gomersall, Giacomo Grasselli, Gonzalo Hernández, Sameer Jog, Antonio Pesenti, Elisabeth D. Riviello, Arthur S. Slutsky, Renee D. Stapleton, Daniel Talmor, Arnaud W. Thille, Laurent Brochard, Karen E. A. Burns,

Tracheal and airway disorders

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. We formed a guideline panel composed of clinicians, methodologists and experts in respiratory medicine. Using GRADE, the panel developed recommendations for four actionable questions. 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). 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.