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

Rochwerg, Bram; Einav, Sharon; Chaudhuri, Dipayan; Mancebo, Jordi; Mauri, Tommaso; Helviz, Yigal; Goligher, Ewan C.; Jaber, Samir; Ricard, Jean-Damien; Rittayamai, Nuttapol; Roca, Oriol; Antonelli, Massimo; Maggiore, Salvatore Maurizio; Demoule, Alexandre; Hodgson, Carol L.; Mercat, Alain; Wilcox, M. Elizabeth; Granton, David; Wang, Dominic; Azoulay, Elie; Ouanes-Besbes, Lamia; Cinnella, Gilda; Rauseo, Michela; Carvalho, Carlos; Dessap-Mekontso, Armand; Fraser, John; Frat, Jean-Pierre; Gomersall, Charles; Grasselli, Giacomo; Hernandez, Gonzalo; Jog, Sameer; Pesenti, Antonio; Riviello, Elisabeth D.; Slutsky, Arthur S.; Stapleton, Renee D.; Talmor, Daniel; Thille, Arnaud W.; Brochard, Laurent; Burns, Karen E. A.

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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00134-020-06312-y) contains supplementary material, which is available to authorized users.