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Who is nasal high flow (NHF) for, i.e. who might benefit from NHF therapy?

  • The short answer is patients breathing on their own (who don’t require immediate mechanical ventilation) with or at risk of respiratory distress, i.e. patients presenting with:
respiratory rate
Dyspnea High work
of breathing
Low SpO2 High PaCO2
  • However, the key to really understanding who can benefit from High Flow therapy is in understanding the mechanisms of action.
  • In an acute setting (Emergency Department or Intensive Care Unit), clinicians typically view NHF as a way of meeting or exceeding a patient’s inspiratory demand so the work of breathing is reduced in patients experiencing respiratory distress – delivering a controlled amount of oxygen to patients with comfort and convenience.
  • In a chronic setting (respiratory ward, long-term care facility or home), clinicians may (for example) prescribe NHF primarily to help a patient with secretion clearance and secondarily to provide respiratory support.
  • Protocols based on published research are starting to emerge for some patient populations. One of the first of these was published in 2017 by Ischaki et al. and is specific to patients with acute hypoxemic respiratory failure (AHRF). Others have been published by Ricard et al 2019, d’Espiney et al 2020 (hypercapnia), Pantazopoulos et al 2020 (COPD with Hypercapnic respiratory failure) and Raoof et al 2020 (COVID-19).

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