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

doi:10.1007/s00134-020-06312-y

. 2020 Dec;46(12):2226-2237.

doi: 10.1007/s00134-020-06312-y. Epub 2020 Nov 17.

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

Bram Rochwerg^{1

2}, Sharon Einav^{3

4}, Dipayan Chaudhuri¹, Jordi Mancebo⁵, Tommaso Mauri^{6

7}, Yigal Helviz³, Ewan C Goligher^{8

9}, Samir Jaber¹⁰, Jean-Damien Ricard^{11

12}, Nuttapol Rittayamai¹³, Oriol Roca^{14

15}, Massimo Antonelli^{16

17}, Salvatore Maurizio Maggiore¹⁸, Alexandre Demoule^{19

20}, Carol L Hodgson^{21

22}, Alain Mercat²³, M Elizabeth Wilcox^{8

9}, David Granton¹, Dominic Wang¹, Elie Azoulay²⁴, Lamia Ouanes-Besbes^{25

26}, Gilda Cinnella²⁷, Michela Rauseo²⁷, Carlos Carvalho²⁸, Armand Dessap-Mekontso^{29

30}, John Fraser^{31

32}, Jean-Pierre Frat³³, Charles Gomersall³⁴, Giacomo Grasselli^{6

7}, Gonzalo Hernandez³⁵, Sameer Jog³⁶, Antonio Pesenti³⁷, Elisabeth D Riviello³⁸, Arthur S Slutsky^{9

39

40}, Renee D Stapleton⁴¹, Daniel Talmor⁴², Arnaud W Thille⁴³, Laurent Brochard^{9

40}, Karen E A Burns^{44

45

46}

Affiliations

¹ Department of Medicine, McMaster University, Hamilton, ON, Canada.
² Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
³ General Intensive Care Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
⁴ Faculty of Medicine, Hebrew University, Jerusalem, Israel.
⁵ Servei de Medicina Intensiva, Hospital Universitari Sant Pau, Barcelona, Spain.
⁶ Dipartimento Di Fisopatologia Medico-Chirurgica E Dei Trapianti, Università Degli Studi Di Milano, Milan, Italy.
⁷ Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
⁸ Department of Medicine, Division of Respirology, University Health Network, Toronto, Canada.
⁹ Interdepartment Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
¹⁰ University Hospital of Montpellier and Saint Eloi Hospital, Montpellier University, Montpellier, France.
¹¹ Assistance Publique-Hôpitaux de Paris, DMU ESPRIT, Médecine Intensive Réanimation, Hôpital Louis Mourier, 92700, Colombes, France.
¹² Université de Paris, IAME, U1137, Inserm, 75018, Paris, France.
¹³ Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
¹⁴ Servei de Medicina Intensiva, Hospital Universitari Vall D'Hebron, Institut de Recerca Vall D'Hebron, Barcelona, Spain.
¹⁵ Ciber Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
¹⁶ Department of Anesthesiology Intensive Care and Emergency Medicine, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy.
¹⁷ Istituto Di Anestesiologia E Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy.
¹⁸ University Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University of Chieti-Pescara and Clinical, Department of Anesthesia, Critical Care and Pain Medicine, SS. Annunziata Hospital, Chieti, Italy.
¹⁹ Sorbonne Université, INSERM, UMRS1158, Neurophysiologie Respiratoire Expérimentale Et Clinique, Paris, France.
²⁰ Service de Pneumologie, Médecine Intensive Et Réanimation, Département R3S, AP-HP Sorbonne Université, Hospital Pitié-Salpêtrière, Paris, France.
²¹ Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia.
²² Department of Intensive Care, Alfred Health, Melbourne, Australia.
²³ Département de Médecine Intensive-Réanimation, CHU D'Angers, Université D'Angers, Angers, France.
²⁴ Service de Médecine Intensive Et Réanimation. APHP, Hôpital Saint-Louis, Université de Paris, Paris, France.
²⁵ Intensive Care Unit, CHU F. Bourguiba Monastir, Université de Monastir, 5000, Monastir, Tunisia.
²⁶ Research Lab, Cardiopulmonary Research in Intensive Care and Toxicology, LR12SP15, Monastir, Tunisia.
²⁷ Department of Anesthesia and Intensive Care, University of Foggia, Foggia, Italy.
²⁸ Pulmonary Division, Hospital das Clinicas - Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
²⁹ AP-HP; Hôpitaux universitaires Henri Mondor, Service de Médecine Intensive Réanimation, 94010, Créteil, France.
³⁰ Faculté de Santé de Créteil, Université Paris Est Créteil, GRC CARMAS, 94010, Créteil, France.
³¹ Critical Care Research Group, University of Queensland, Brisbane, Australia.
³² Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Australia.
³³ CHU de Poitiers, Réanimation Médicale, INSERM, CIC-1402, équipe 5 ALIVE, Faculté de Médecine Et de Pharmacie de Poitiers, Université de Poitiers, Poitiers, France.
³⁴ Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
³⁵ University Hospital Virgen de La Salud, Toledo, Spain.
³⁶ Department of Intensive Care Medicine, Deenanath Mangeshkar Hospital and Research Centre, Pune, India.
³⁷ Department of Pathophysiology and Transplantation, 9304, Universita Degli Studi Di Milano, Milano, Italy.
³⁸ Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA.
³⁹ Keenan Research Center, Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, Canada.
⁴⁰ Department of Medicine (Critical Care Medicine), Unity Health Toronto, St. Michael's Hospital, Li Ka Shing Knowledge Institute, 30 Bond Street, Office 4-045 Donnelly Wing, Toronto, M5B 1W8, Canada.
⁴¹ Division of Pulmonary and Critical Care Medicine, University of Vermont Larner College of Medicine, Burlington, VT, USA.
⁴² Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.
⁴³ Centre Hospitalier Universitaire de Poitiers, Médecine Intensive Réanimation, INSERM CIC 1402 ALIVE Research Group, University of Poitiers, Poitiers, France.
⁴⁴ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada. Karen.Burns@unityhealth.to.
⁴⁵ Interdepartment Division of Critical Care Medicine, University of Toronto, Toronto, Canada. Karen.Burns@unityhealth.to.
⁴⁶ Department of Medicine (Critical Care Medicine), Unity Health Toronto, St. Michael's Hospital, Li Ka Shing Knowledge Institute, 30 Bond Street, Office 4-045 Donnelly Wing, Toronto, M5B 1W8, Canada. Karen.Burns@unityhealth.to.

PMID: 33201321
PMCID: PMC7670292
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 et al. Intensive Care Med. 2020 Dec.

. 2020 Dec;46(12):2226-2237.

doi: 10.1007/s00134-020-06312-y. Epub 2020 Nov 17.

Authors

Affiliations

¹ Department of Medicine, McMaster University, Hamilton, ON, Canada.
² Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
³ General Intensive Care Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
⁴ Faculty of Medicine, Hebrew University, Jerusalem, Israel.
⁵ Servei de Medicina Intensiva, Hospital Universitari Sant Pau, Barcelona, Spain.
⁶ Dipartimento Di Fisopatologia Medico-Chirurgica E Dei Trapianti, Università Degli Studi Di Milano, Milan, Italy.
⁷ Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
⁸ Department of Medicine, Division of Respirology, University Health Network, Toronto, Canada.
⁹ Interdepartment Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
¹⁰ University Hospital of Montpellier and Saint Eloi Hospital, Montpellier University, Montpellier, France.
¹¹ Assistance Publique-Hôpitaux de Paris, DMU ESPRIT, Médecine Intensive Réanimation, Hôpital Louis Mourier, 92700, Colombes, France.
¹² Université de Paris, IAME, U1137, Inserm, 75018, Paris, France.
¹³ Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
¹⁴ Servei de Medicina Intensiva, Hospital Universitari Vall D'Hebron, Institut de Recerca Vall D'Hebron, Barcelona, Spain.
¹⁵ Ciber Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
¹⁶ Department of Anesthesiology Intensive Care and Emergency Medicine, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy.
¹⁷ Istituto Di Anestesiologia E Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy.
¹⁸ University Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University of Chieti-Pescara and Clinical, Department of Anesthesia, Critical Care and Pain Medicine, SS. Annunziata Hospital, Chieti, Italy.
¹⁹ Sorbonne Université, INSERM, UMRS1158, Neurophysiologie Respiratoire Expérimentale Et Clinique, Paris, France.
²⁰ Service de Pneumologie, Médecine Intensive Et Réanimation, Département R3S, AP-HP Sorbonne Université, Hospital Pitié-Salpêtrière, Paris, France.
²¹ Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia.
²² Department of Intensive Care, Alfred Health, Melbourne, Australia.
²³ Département de Médecine Intensive-Réanimation, CHU D'Angers, Université D'Angers, Angers, France.
²⁴ Service de Médecine Intensive Et Réanimation. APHP, Hôpital Saint-Louis, Université de Paris, Paris, France.
²⁵ Intensive Care Unit, CHU F. Bourguiba Monastir, Université de Monastir, 5000, Monastir, Tunisia.
²⁶ Research Lab, Cardiopulmonary Research in Intensive Care and Toxicology, LR12SP15, Monastir, Tunisia.
²⁷ Department of Anesthesia and Intensive Care, University of Foggia, Foggia, Italy.
²⁸ Pulmonary Division, Hospital das Clinicas - Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
²⁹ AP-HP; Hôpitaux universitaires Henri Mondor, Service de Médecine Intensive Réanimation, 94010, Créteil, France.
³⁰ Faculté de Santé de Créteil, Université Paris Est Créteil, GRC CARMAS, 94010, Créteil, France.
³¹ Critical Care Research Group, University of Queensland, Brisbane, Australia.
³² Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Australia.
³³ CHU de Poitiers, Réanimation Médicale, INSERM, CIC-1402, équipe 5 ALIVE, Faculté de Médecine Et de Pharmacie de Poitiers, Université de Poitiers, Poitiers, France.
³⁴ Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
³⁵ University Hospital Virgen de La Salud, Toledo, Spain.
³⁶ Department of Intensive Care Medicine, Deenanath Mangeshkar Hospital and Research Centre, Pune, India.
³⁷ Department of Pathophysiology and Transplantation, 9304, Universita Degli Studi Di Milano, Milano, Italy.
³⁸ Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA.
³⁹ Keenan Research Center, Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, Canada.
⁴⁰ Department of Medicine (Critical Care Medicine), Unity Health Toronto, St. Michael's Hospital, Li Ka Shing Knowledge Institute, 30 Bond Street, Office 4-045 Donnelly Wing, Toronto, M5B 1W8, Canada.
⁴¹ Division of Pulmonary and Critical Care Medicine, University of Vermont Larner College of Medicine, Burlington, VT, USA.
⁴² Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.
⁴³ Centre Hospitalier Universitaire de Poitiers, Médecine Intensive Réanimation, INSERM CIC 1402 ALIVE Research Group, University of Poitiers, Poitiers, France.
⁴⁴ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada. Karen.Burns@unityhealth.to.
⁴⁵ Interdepartment Division of Critical Care Medicine, University of Toronto, Toronto, Canada. Karen.Burns@unityhealth.to.
⁴⁶ Department of Medicine (Critical Care Medicine), Unity Health Toronto, St. Michael's Hospital, Li Ka Shing Knowledge Institute, 30 Bond Street, Office 4-045 Donnelly Wing, Toronto, M5B 1W8, Canada. Karen.Burns@unityhealth.to.

PMID: 33201321
PMCID: PMC7670292
DOI: 10.1007/s00134-020-06312-y

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.

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Conflict of interest statement

SE received funding for travel, given lectures, owns patents with and/or performed consultancy work for Zoll, Medtronic and Diasorin and has participated in multicentre trials run by Artisanpharma, Eisai and Astra Zeneca. JM received personal fees from Faron Pharmaceuticals, Medtronic and Janssen; IMT Medical provided travel and hotel expenses to attend a meeting; he is a coinvestigator on a PAV + multinational trial funded by the CIHR in partnership with Covidien (Medtronic); more than 3 years ago Fisher-Paykel, General Electric and A-Lung provided grant funding to conduct clinical research. TM received lecture fees from Drager, Fisher and Paykel, Mindray and BBraun. EG supported by an Early Career Investigator award from the Canadian Institutes of Health Research. He receives financial and nonfinancial support from Getinge and Timpel outside the submitted work. SJ received Consulting fees from Drager, Xenios, and Fisher & Paykel. J-DR received travel expenses and accommodation coverage from Fisher&Paykel Healthcare to attend scientific meetings. Fisher&Paykel Healthcare provided support for the ongoing High Flow ACRF trial (NCT03406572) but took no part in design or conduct of the study. NR received travel expenses and lecture fees from Fisher&Paykel. OR’s institution received fees for consultation from Hamilton Medical and received lecture fees from Air Liquide. MA’s institution received unrestricted research grant from Fisher & Paykel and GE Healthcare, he received consulting fees from Getinge and Intersurgical. SMM received consulting fees from Draeger Medical and General Electric Healthcare; his Institution received a research grant from Fisher and Paykel Healthcare (the RINO trial, clinicaltrials.gov NCT02107183). AD reports research grants from Philips, Respinor, Lungpacer, French Ministry of Health, Fisher and Paykel Healthcare (the RINO trial, clinicaltrials.gov NCT02107183), financial and nonfinancial support from Fisher&Paykel (including payment for lectures and registration to one scientific meeting), personal fees from Baxter (board meeting), Hamilton (lecture), Getinge (lecture), Lowenstein (advisory board). CH was supported by a Heart Foundation Fellowship. AM received personal fees from Faron Pharmaceuticals, Air Liquid Medical Systems, Pfizer, Resmed and Draeger and grants and personal fees from Fisher and Paykel and Covidien. EA has received fees for lectures from Gilead, Pfizer, Baxter, and Alexion. His research group has been supported by Ablynx, Fisher & Paykel, Jazz Pharma, and MSD. GC received consulting fees from Maquet. AD-M reports research grants from Fisher Paykel, Baxter, Philips, Ferring and GSK; participation to advisory board for Air Liquide, Baxter, and Amomed, lectures for Getinge and Addmedica. JF received grant funding and travel support to meetings from Fisher Paykel ( no role in research from FP) and Xenios. His research group has received research support from CSL, Timpel, Draeger. J-PF received travel expenses and lectures fees from Fisher&Paykel and SOS oxygene. GG received travel expenses and lecture fees from Getinge, Draeger Medical, MSD, Fisher&Paykel, Thermofisher and Biotest. GH received personal fees and travel expenses from Fisher and Paykel Healthcare. AT received financial and nonfinancial support from Fisher&Paykel (including payment for lectures and travel expense coverage to attend scientific meetings), and received financial support from Covidien, Maquet-Getinge, and GE Healthcare outside the submitted work. LB conducts an investigator-initiated trial on PAV + funded by the Canadian Institute for Health Research in partnership with Medtronic Covidien. His laboratory also received grants and non-financial support from Fisher & Paykel, non-financial support from Air Liquide, non-financial support from Philips, non-financial support from Sentec, other from General Electric.

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References

1. Nishimura M. High-flow nasal cannula oxygen therapy in adults: physiological benefits, indication, clinical benefits, and adverse effects. Respir Care. 2016;61(4):529–541. - PubMed
1. Papazian L, Corley A, Hess D, et al. Use of high-flow nasal cannula oxygenation in ICU adults: a narrative review. Intensive Care Med. 2016;42(9):1336–1349. - PubMed
1. Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ (Clin Res Ed) 2008;336(7650):924–926. - PMC - PubMed
1. Ito J, Nagata K, Sato S, et al. The clinical practice of high-flow nasal cannula oxygen therapy in adults: a Japanese cross-sectional multicenter survey. Respir Investig. 2018;56(3):249–257. - PubMed
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[1] Nishimura M. High-flow nasal cannula oxygen therapy in adults: physiological benefits, indication, clinical benefits, and adverse effects. Respir Care. 2016;61(4):529–541. - PubMed

[2] Nishimura M. High-flow nasal cannula oxygen therapy in adults: physiological benefits, indication, clinical benefits, and adverse effects. Respir Care. 2016;61(4):529–541. - PubMed

[3] Papazian L, Corley A, Hess D, et al. Use of high-flow nasal cannula oxygenation in ICU adults: a narrative review. Intensive Care Med. 2016;42(9):1336–1349. - PubMed

[4] Papazian L, Corley A, Hess D, et al. Use of high-flow nasal cannula oxygenation in ICU adults: a narrative review. Intensive Care Med. 2016;42(9):1336–1349. - PubMed

[5] Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ (Clin Res Ed) 2008;336(7650):924–926. - PMC - PubMed

[6] Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ (Clin Res Ed) 2008;336(7650):924–926. - PMC - PubMed

[7] Ito J, Nagata K, Sato S, et al. The clinical practice of high-flow nasal cannula oxygen therapy in adults: a Japanese cross-sectional multicenter survey. Respir Investig. 2018;56(3):249–257. - PubMed

[8] Ito J, Nagata K, Sato S, et al. The clinical practice of high-flow nasal cannula oxygen therapy in adults: a Japanese cross-sectional multicenter survey. Respir Investig. 2018;56(3):249–257. - PubMed

[9] Besnier E, Hobeika S, Nseir S, et al. High-flow nasal cannula therapy: clinical practice in intensive care units. Ann Intensive Care. 2019;9(1):98. - PMC - PubMed

[10] Besnier E, Hobeika S, Nseir S, et al. High-flow nasal cannula therapy: clinical practice in intensive care units. Ann Intensive Care. 2019;9(1):98. - PMC - PubMed

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

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

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