High Flow Nasal Cannula

Overview:

In this episode of EMRA*Cast, Dr. Jessie Werner and Dr. Jessica Whittle discuss high flow nasal cannula. Unsure of the difference among nasal cannula, a venti mask or a non-rebreather? Sick asthmatics? Pedi patients? Pneumonia? Learn when to use this modality to improve patient comfort and help stave off intubation.

Key Points:

• Regular nasal cannula goes up to 15L/min but patients are really only getting about 6L/min because of outside air mixing in
• The progression of FiO2 goes nasal cannula🡪venti🡪non-rebreather 
• High flow nasal cannula goes up to about 40L/min of flow and is humidified so it’s more comfortable for patients
• Evidence points to a mortality benefit using high flow nasal cannula in pneumonia patients

References:  

• Jentzer, Jacob, Cameron Dezfulian, and Lillian Emlet. "High-Flow Oxygen through Nasal Cannula in Acute Hypoxemic Respiratory Failure: the FLORALI study." F1000Research 5.41 (2016): 41.
• Frat, Jean-Pierre, et al. "Preoxygenation with non-invasive ventilation versus high-flow nasal cannula oxygen therapy for intubation of patients with acute hypoxaemic respiratory failure in ICU: the prospective randomised controlled FLORALI-2 study protocol." BMJ open 7.12 (2017): e018611.
• Milési, Christophe, et al. "High flow on the rise—pediatric perspectives on the FLORALI trial." Journal of thoracic disease 7.8 (2015): E230.