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Is nasal high flow (NHF) suitable for treating patients with hypercapnic respiratory failure?

NHF has been proven to reduce PaCO2 in COPD patients. Pantazopoulos et al. 2020. provides a review of the literature and proposes a treatment algorithm for COPD patients.

So, if the patient is:
  1. spontaneously breathing
  2. may benefit from a reduced PaCO2 or any of the other benefits of NHF
  3. is not otherwise indicated for mechanical ventilation (see guidance docs below)

NHF may be a suitable treatment.

Emerging guidelines address efficacy in this population, see below. 

Evidence-based clinical practice guidelines

For respiratory support, the guidelines recommend the use of non-invasive ventilation (NIV) for indications where increased alveolar ventilation or pressure support are required, such as in acute hypercapnic respiratory failure  (CMD 7) 

Hundreds of randomized controlled trials have been consolidated into clinical practice guidelines. 

These guidelines underscore the breadth of application of nasal high flow therapy.

We’ve created a table that will help you review the  guidelines by patient population and application.


Explore the NHF guidelines table