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.
1 2, B. R., 3 4, S. E., 1, D. C., 5, J. M., 6 7, T. M., 3, Y. H., C Goligher 8 9, E., Jaber 10, S., Ricard 11 12, J., Rittayamai 13, N., Roca 14 15, O., Antonelli, M., Maurizio Maggiore 18, S., Demoule 19 20, A., L Hodgson 21 22, C., Mercat 23, A., Elizabeth Wilcox 8 9, M., 1, D. G., 1, D. W., Azoulay 24, E., Ouanes-Besbes 25 26, L., Cinnella 27, G., Rauseo 27, M., Carvalho 28, C., Dessap-Mekontso 29 30, A., Fraser 31 32, J., Frat 33, J., Gomersall 34, C., 6 7, G. G., Hernandez 35, G., Jog 36, S., Pesenti 37, A., D Riviello 38, E., 9 39 40, A. S. S., D Stapleton 41, R., Talmor 42, D., W Thille 43, A., 9 40, L. B., A Burns, K. E., (Abstract) The role for high flow nasal cannula as a respiratory support strategy in adults: a clinical practice guideline, <<INTENSIVE CARE MEDICINE>>, 2020; (12): 2226-2237. [doi:10.1007/s00134-020-06312-y] [http://hdl.handle.net/10807/166310]
The role for high flow nasal cannula as a respiratory support strategy in adults: a clinical practice guideline
Antonelli, Massimo;
2020
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.
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