Optiflow FAQs

FAQ

FAQs - Nasal High Flow

Optiflow usage: There is an ever–increasing body of clinical literature which may provide guidance on day–to–day application of HF therapy. Here are the 6 most frequently asked questions from clinicians.

Is there a protocol for use of Nasal High Flow?
What flow rates are typical for Nasal High Flow use?
How much pressure is generated by Nasal High Flow?
How quickly does Optiflow Nasal High Flow work?
Is there a bedside tool to predict the outcome of Nasal High Flow?
Who does Nasal High Flow work on?
What effect does low humidity have on the airway?

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Is there a protocol for use of Nasal High Flow?

Ischaki 2017, European Respiratory Review.

Ischaki proposed the following algorithm for use on patients with acute hypoxemic respiratory failure.

Open "Flow Matters" featuring Ischaki

Take me to the PubMed abstract

Ischaki E, Pantazopoulos I, Zakynthinos S. Nasal high flow therapy: a novel treatment rather than a more expensive oxygen device. Eur Respir Rev. 2017;26(145):170028.

Adapted from above original paper; used under Creative Commons licence 4.0. MV = mechanical ventilation; SOT = standard oxygen treatment.
Please note: this material is intended exclusively for healthcare practitioners and the information conveyed constitutes neither medical advice nor instructions for use. This material should not be used for training purposes or to replace individual hospital policies or practices. Before any product use, consult the appropriate user instructions.

What flow rates are typical for Nasal High Flow use?

The following table lists starting flows and flow ranges used in clinical studies for Optiflow HF therapy.

Macé J, Marjanovic N, Faranpour F, Mimoz O, Frerebeau M, Violeau M, et al. Early high–flow nasal cannula oxygen therapy in adults with acute hypoxemic respiratory failure in the ED: A before–after study. Am J Emerg Med. 2019 Mar 5. [Epub ahead of print]

Hernández G, Vaquero C, Colinas L, Cuena R, González P, Canabal A et al. Effect of Postextubation High–Flow Nasal Cannula vs Noninvasive Ventilation on Reintubation and Postextubation Respiratory Failure in High–Risk Patients. JAMA. (Oct) 2016; 316(15):1565–74.
Hernández G, Vaquero C, González P, Subira C, Frutos-Vivar F, Rialp G et al. Effect of Postextubation High–Flow Nasal Cannula vs Conventional Oxygen Therapy on Reintubation in Low–Risk Patients: A Randomized Clinical Trial. JAMA. (Apr) 2016; 315(13):1354–61.
Bell N, Hutchinson CL, Green TC, Rogan E, Bein KJ, Dinh MM. Randomised control trial of humidified high flow nasal cannulae versus standard oxygen in the emergency department. Emerg Med Australas. 2015 Dec; 27(6):537–41.
Frat JP, Thille AW, Mercat A, Girault C, Ragot S, Perbet S et al. High–Flow Oxygen through Nasal Cannula in Acute Hypoxemic Respiratory Failure. N Engl J Med. 2015; 372(23):2185–96.
Stéphan F, Barrucand B, Petit P, Rézaiguia–Delclaux S, Médard A, Delannoy B et al. High–Flow Nasal Oxygen vs Noninvasive Positive Airway Pressure in Hypoxemic Patients After Cardiothoracic Surgery: A Randomized Clinical Trial. JAMA. 2015; 13(23):2331–9.
Peters S, Holets S, Gay P. High–Flow Nasal Cannula Therapy in Do–Not–Intubated Patients with Hypoxemic Respiratory Distress. Respir Care. 2013; 58(4): 597–600.
Sztrymf B, Messika J, Bertrand F, Hurel D, Leon R, Dreyfuss D et al. Beneficial effects of humidified high flow nasal oxygen in critical care patients: a prospective pilot study. Intensive Care Med. 2011; 37(11):1780–6.
Parke R, McGuinness S, Eccleston M. A Preliminary Randomized Controlled Trial to Assess Effectiveness of Nasal High–Flow Oxygen in Intensive Care Patients. RespirCare. (Mar) 2011; 56(3): 265–70.
Corley A, Caruana LR, Barnett AG, Tronstad O, Fraser JF. Oxygen delivery through high–flow nasal cannulae increase end–expiratory lung volume and reduce respiratory rate in post–cardiac surgical patients. Br J Anaesth. 2011; 107(6):998–1004.
Storgaard LH, Hockey HU, Laursen BS, Weinreich UM. Long–term effects of oxygen–enriched high–flow nasal cannula treatment in COPD patients with chronic hypoxemic respiratory failure. Int J Chron obstruct Pulmon Dis. 2018; 13:1195–205.
Nagata K, Kikuchi T, Horie T, Shiraki A, Kitajima T, Kadowaki T et al. Domiciliary High–Flow Nasal Cannula Oxygen Therapy for Patients with Stable Hypercapnic Chronic Obstructive Pulmonary Disease. A multicenter Randomized Crossover Trial. Ann Am Thorac Soc. 2018;15(4):432–9.
Cirio S, Piran M, Vitacca M, Piaggi G, Ceriana P, Prazzoli M et al. Effects of heated and humidified high flow gases during high–intensity constant–load exercise on severe COPD patients with ventilatory limitation. Respir Med. 2016;118:128–32.
Rea H, McAuley S, Jayaram L, Garrett J, Hockey H, Storey L et al. The clinical utility of long–term humidification therapy in chronic airway disease. Respir Med. 2010; 104(4): 525–33.

View additional references

How much pressure is generated by Nasal High Flow?

Average pressure increases approximately 0.5 - 1 cmH₂O per 10 L/min.

Pressure ranges are cannula and patient dependent. For illustrative purposes only.

Ritchie JE, Williams AB, Gerard C, Hockey H. Evaluation of a humidified nasal highflow oxygen system, using oxygraphy, capnography and measurement of upper airway pressures. Anaesth Intensive Care. 2011; 39(6):1103–10.

Parke RL, Eccleston ML, McGuiness SP. The Effects of Flow on Airway Pressure During Nasal High–Flow Oxygen Therapy. Respir Care. (Aug) 2011; 56(8):1151–5.
Groves N, Tobin A. High flow nasal oxygen generates positive airway pressure in adult volunteers. Aust Crit Care. 2007; 20(4):126–31.

View additional references

How quickly does Optiflow Nasal High Flow work?

Sztrymf associated Optiflow HF therapy with sustained beneficial effects on oxygenation and physiological
parameters for patients with acute respiratory failure. Similarly Rittayamai showed significant improvement
in post-extubation patients. These studies may provide guidance on patient responses to the therapy.

Rittayamai N, Tscheikuna J, Praphruetkit N, Kijpinyochai S. Use of High-Flow Nasal Cannula for Acute Dyspnea and Hypoxemia in the Emergency Department. Respir Care. 2015; 60(10):1377–82.

Rittayamai N, Tscheikuna J, Rujiwit P. High–Flow Nasal Cannula Versus Conventional Oxygen Therapy After Endotracheal Extubation: A Randomized Crossover Physiologic Study. Respir Care. 2014; 59(4): 485–90.
Sztrymf B, Messika J, Bertrand F, Hurel D, Leon R, Dreyfuss D et al. Beneficial effects of humidified high flow nasal oxygen in critical care patients: a prospective pilot study. Intensive Care Med. 2011; 37(11):1780–6.
Lenglet H, Sztrymf B, Leroy C, Brun P, Dreyfuss D, Ricard JD. Humidified High Flow Nasal Oxygen During Respiratory Failure in the Emergency Department: Feasibility and Efficacy. Respir Care. 2012; 57(11):1873–8.

View additional references

Is there a bedside tool to predict the outcome of Nasal High Flow?

The validated ROX index predicts failure in adults with AHRF receiving NHF.

4 time intervals are observed: 2, 6, 12 and >12 hours. It's an easy-to-use dynamic bedside tool.

Open ROX clinical presentation

Take me to the Pubmed abstract

Roca O, Caralt B, Messika J, Samper M, Sztrymf B, Hernandez G, et al. An Index Combining Respiratory Rate and Oxygenation to Predict Outcome of Nasal High Flow Therapy. Am J Respir Crit Care Med. 2018 Dec 21. [Epub ahead of print]

Who does Nasal High Flow work on?

The short answer is spontaneously breathing patients with, or at risk of respiratory distress.

Is your patient presenting with:

LOW SpO₂	HIGH PaCO₂	HIGH Respiratory Rate
HIGH Work of Breathing	Dyspnea

The key to really understanding who can benefit from HF is in understanding the mechanisms of HF.

Learn more about mechanisms

What effect does low humidity have on the airway?

Optiflow High Flow airway hydration mechanism overview

Even a 10% drop in humidity (in the airway) can have a detrimental effect on mucociliary clearance transport, a crucial part of the upper airway defense system.

What next?

F&P Optiflow™+ Nasal Cannula

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Optiflow™ Nasal High Flow at the Royal Berkshire Hospital

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