This uploaded file is open for all fields of sphere

1. NASAL HIGH FLOW
Dr Nisar Ahmed Arain
Assistant Professor
Anesthesia/Critical care/ER

2. High Flow Nasal Cannula and
Humidification

3. OVER VIEW
-Risks
- Respiratoryfailure
- Preventingintubation
-Peri-intubation
- Post extubationtherapy
- Questions
-What is HFNC
- KeyPoints
-Indications
-Contraindications
-Complications
-Positiveeffects

4. •Oxygen and air source
•Air-oxygen blender generates up
to FiO2 1.0 at a flow rate of up to
60L/min
•Active heated humidifier capable of
providing 100% body humidity
•Single limb heated inspiratory
circuit (avoids heat loss and
condensation)
•Lightweight, flexible delivery tubing
•Adjustable head strap
•Soft and flexible nasal prongs
•Different brands are available (e.g.
Optiflow™)
High Flow Nasal Cannula (Opti flow)

5. Key Points
-The amount of oxygen
patients get depends on
their inspiratory flow rate.
-Masks do notdeliver
consistent levels of
oxygen, where as HFNC
does.
-Deadspace is washed out
during its application
-Is not a reliable form of
PEEP

6. Indications
Hypoxic respiratory failure
-Community-acquired
pneumonia
-Viral pneumonia (e.g.influenza)
-Acute asthma
-Cardiogenic pulmonary edema
-Pulmonaryembolism
-Interstitialpneumonia
-Carbon monoxidepoisoning
Also needed for High FiO2
oxygen delivery in the
following conditions
-
-
1-before and after intubation
2-post cardiac surgery
3-oxygen supply during
invasive procedures
a-Trans-oral endoscopy
(TOE) upper GI
b-Endoscopy

7. -Contraindications
-Epistaxis
-Baseof skull fracture
-Surgery to the nose or
upper aero digestive
tract
-Nasal obstruction e.g.
nasal fracture, tenacious
secretions,tumour

8. Complications
- Local trauma, discomfort and
pressure areas
- Epistaxis
- Gastricdistension
- Blocked cannulae due to
secretions

9. Positive effects

10. should be a two hour limit on HFNC
Risks
-He is doing ok on that,lets not
intubate……
- In patients who are acutely
unwell with high oxygen/flow
rates, trial
- It should NOT delayintubation
- Failure of HFNC might cause
delayed intubation and worse
clinical outcomes in patients
with respiratory failure. e

11. Respiratory failure (Type 1)
-Gold standard for Type 2 is still
BiPAP
- No bigstudies yet
-One small study comparedtreating
patients in acute respiratory
failure with facemasks and HFNC
- They found that the HFNC
improved the patients PaO2and
was associated wIthalower
respiratory rate

12. Respiratory failure continued
- A second study evaluated the efficiency, safety
and outcome of high flow nasal cannula
oxygen (HFNC) in ICU patients with acute
respiratory failure
- HFNC significantly reduced the respiratory rate,
heart rate and increased pulse oximetry
-These improvements were observed as early as
15M after the beginning of HFNC for respiratory
rate and pulse oximetery. PaO2 and PaO2/FiO2
increased significantly after one hour, HNFC in
comparison with base line

13. Preventing intubation
-One study compared standard therapy
NIV and HFNC in patients with type 1
respiratory failure
-They found the intubation rate was
lower in the HFNC group (38% of
patients compared with 47% in the
standard and 50% in the NIV group)
but this was not statistically
significant.
- It did show an improvement in
ventilator free days and 90 day
mortality

14. Preventing intubation
-A study which looked at
respiratory failure in do not
intubate patients treated
with HFNC first and escalated
to NIV if HFNCfailed
-The study showed that HFNC
was effective in increasing
oxygen saturations and
lowered respiratory rate.
-9 of the 50 (18%) patients
recruited had to be
escalated to NIV

15. Peri-intubation
-Preoxygenation andapnoeic
Oxygenation
- Compared to HFFM (high
flow face mask), HFNCasa
preoxygenation device did
not reduce the lowest level
of desaturation in an RCT
(Vour’ch et al, 2015 –
PREOXYFLOW trial)

16. -Peri-intubation continued
- A case series of 25 patients with
difficult airways undergoing
general anesthesia for
hypopharyngeal or
laryngotracheal surgery had
mean apnoea times of 14
minutes without desaturation
(i.e. SaO2 >90)

17. Post extubation therapy
-Evidence is coming through that we
should be extubating onto HFNCin
all patient
- Compared to facemask, in low risk
patients, at the same FiO2 aswhen
ventilated, there were less episodes
of desaturation (75% to 40%) and
reintubation rates were reduced
(21% to 4%). (Maggiore et al, 2014)

18. Post extubation therapy continued
-A second study compared highand
low risk patients extubated onto
“conventional oxygen therapy” and
optiflow
-Compared to the conventional therapy
patients experienced lower rates of
respiratory failure leading to
reintubation ( 12% to 5%)

19. CLEANING
-We all know how to clean an
Optiflow, hopefully!!
-What about weaning? 2hours
on 2 hours off
- Do you need a newset
-When you do
- When you don’t

20. STOP THEPRESSES!!
--A meta analysis published in late
2017 showed that HFNCis
superior to standard oxygen
therapy in preventing intubation
--It also showed no diffrence in
intubation rates between HFNC
and NIV
-- The recommend further RCT’s

21. Conclusion
-What HFNCis
-What its goodfor
-What its not good for
-Should HFNCbe our first line
treatment for Type 1RF
-Good or bad forperi-intubation
-Should we extubate onto HFNC
routinely

22. Questions & Discussion

23. THANK YOU