Nasal high flow confers benefits that conventional oxygen therapies cannot. It's a significantly more sophisticated form of respiratory support,  that includes the provision of dynamic, positive airway pressure, and reduction of dead space

The airway hydration resulting from heating and humidifying the air is critical to facilitating comfortable treatment but is equally valuable in preserving mucociliary function. This is why it's at the heart (or more lungs) of this therapy. 

As with any treatment, patient comfort is a significant factor. One of the standout features of NHF is the level of respiratory support that can be achieved without the downsides of a mask.

Below is an overview of how each mechanism contributes to the therapy, with some cool videos showing the effects in action.

NHF therapy foundations, a must-do short course.  

Even if you're a high-flow pro, this short course is a great place to start before diving into the details of the mechanisms of high flow therapy. 

Answers to these questions and more

Continue your high flow therapy learning journey with this short, interactive module on the F&P Education Hub. 

 

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Reduction of dead space



Clearance of expired air in the upper airways reduces rebreathing of gas high in CO2 and depleted O2, increasing alveolar ventilation.

Dynamic, positive airway pressure



NHF creates breath and flow-dependent pressure, making inspiration
easier and promoting slow, deep breathing on expiration,
thereby increasing alveolar ventilation.

Airway hydration/heated humidification



Humidity enables the comfortable delivery of high flows of gas. Optimized humidity emulates the natural balance of heat and moisture in healthy lungs and may promote physiological stability in compromised airways.  
 

Patient comfort


Respiratory support delivered via a mask poses challenges for clinicians and patients.
NHF delivered via a cannula promotes patient comfort and may improve compliance.

Supplemental oxygen (if required)



Oxygen delivered via conventional oxygen therapy (COT) is 'bone' dry. Delivering oxygen via NHF therapy allows for oxygen to be optimally humidified eliminating the issues associated with exposure of the vulnerable upper airway to dry gas. 
Additionally delivering oxygen via NHF gives you confidence in the accurate delivery of blended oxygen. 

 

How does NHF compare with COT?

Although an NHF device can deliver high oxygen levels (up to 100% O2), it’s not specifically an oxygen delivery device. NHF can be, and is, often used without supplemental oxygen, i.e., with room air – 21% O2.

Conventional oxygen therapy via a low-flow cannula and most styles of oxygen face masks are limited to lower flow rates (up to 10 L/min) partly because the gas is cold and dry, making tolerability a significant issue.

These lower flow rates also limit FiO2 delivery and accuracy and aren’t high enough to offer the benefits of dead-space washout and positive airway pressure.

Typically, “high flow” refers to flow rates above 15 L/min of a fully humidified air and oxygen mix. These higher flow rates enable mechanisms that cold, dry oxygen alone cannot provide.

See the table below for a comparison of standard COT devices and NHF.



 
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