Solutions
High-flow
oxygen therapy
In conventional oxygen therapy, the flow used is usually low, because high flow rates without an appropriate humidity level may cause discomfort. FiO2 received by the patient may also vary, depending greatly on the patient’s inspiratory flow rate.. However, it is now possible to provide oxygen with flows of up to 80 L/min and a high level of humidity through the use of high-flow nasal cannulas (HFNC); solving the inconveniences and issues raised in the past.
Physiological Benefits
Dry and cold gases administered through the nasal cavity produce irritation and drying of the nasal airway mucosa, which reduces the tolerance to the method and increases the mucociliary clearance deterioration.
Using high humidity level HFNC allows tolerance of the administered flows and prevents the impairment of the cleaning and defense mechanisms of the airways. During the weaning period, it alleviates the larynx and trachea inflammation, preventing postextubation failure.
During HFNC application, a reduction in the respiratory rate has been observed, as well as a reduction of the minute volume without PaCO2 increase, which suggests a more efficient ventilation, possibly originated by the CO2 clearance of the upper airway and reduction of dead space.
In conventional oxygen therapy, FiO2 is highly variable, depending greatly on the patient’s inspiratory flow. Through the administration of flows that exceed the inspiratory peak flow, HFNC guarantees continuous and controlled FiO2.
Although HFNC is an open system, the stream flow it uses generates expiratory resistance, which creates a certain level of pressure in the upper airways, equivalent to CPAP levels of up to 5 cmH2O with a similar physiological effect.
Uses and Application
HFNC has been used for some years in practice, and the number of application areas has been increasing:
– Handling pre and postextubation periods.
– Hypoxemic and hypercapnic respiratory failure.
– Heart failure.
– Sleep apnea.
– As an alternative to Non-Invasive Ventilation.
– In handing pediatric and neonatal patients.
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