High flow nasal cannula oxygen therapy, work in progress in respiratory critical care

Annia Schreiber, Fabiano Di Marco, Fulvio Braido, Paolo Solidoro

Research output: Contribution to journalArticlepeer-review


After a planned extubation, the re-occurrence of acute respiratory distress needing the restoration of invasive mechanical support is a severe phenomenon associated with several important consequences, including increased morbidity, Intensive Care Unit mortality, and an enormous financial burden. So far, the most commonly used techniques to ameliorate gas exchange in the postextubation period were low-flow oxygen therapy and non-invasive ventilation (NIV). High flows through nasal cannulae (HFNC) is a system which allows increased CO2 wash-out of anatomical dead space, positive nasopharyngeal pressure, a relatively constant FiO2, and an improvement of mucociliary function. In a recently published paper by Hernandez et al. HFNC therapy, compared in the postextubation period to standard oxygen in patients at low risk of re-intubation, was associated with a lower re-intubation rate within 72 hours of extubation, with no evidence of any delays in re-intubation which may prove fatal, as previously reported in the context of NIV. Despite yielding some useful starting points and positive results with HFNC, some discrepancies have emerged in the findings of the studies in this field. As we await further more homogeneous and enlightening studies, at present we can only affirm that HFNC seems to be a useful means to prevent and treat postextubation hypoxemia. In fact no harmful or adverse effects related to HFNC emerged in any of the studies and globally, it was associated with better comfort and tolerance compared with NIV, which justifies its use as a first alternative to standard oxygen therapy.

Original languageEnglish
Pages (from-to)14-20
Number of pages7
JournalMinerva Medica
Issue number6 Suppl 1
Publication statusPublished - Dec 2016


  • Airway Extubation
  • Cannula
  • Critical Care
  • Humans
  • Noninvasive Ventilation
  • Nose
  • Oxygen Inhalation Therapy
  • Respiratory Distress Syndrome, Adult
  • Journal Article
  • Review


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