The role for high flow nasal cannula as a respiratory support strategy in adults: a clinical practice guideline

Bram Rochwerg, Sharon Einav, Dipayan Chaudhuri, Jordi Mancebo, Tommaso Mauri, Yigal Helviz, Ewan C. Goligher, Samir Jaber, Jean Damien Ricard, Nuttapol Rittayamai, Oriol Roca, Massimo Antonelli, Salvatore Maurizio Maggiore, Alexandre Demoule, Carol L. Hodgson, Alain Mercat, M. Elizabeth Wilcox, David Granton, Dominic Wang, Elie AzoulayLamia Ouanes-Besbes, Gilda Cinnella, Michela Rauseo, Carlos Carvalho, Armand Dessap-Mekontso, John Fraser, Jean Pierre Frat, Charles Gomersall, Giacomo Grasselli, Gonzalo Hernandez, Sameer Jog, Antonio Pesenti, Elisabeth D. Riviello, Arthur S. Slutsky, Renee D. Stapleton, Daniel Talmor, Arnaud W. Thille, Laurent Brochard, Karen E.A. Burns

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197 Citations (Scopus)


Purpose: High flow nasal cannula (HFNC) is a relatively recent respiratory support technique which delivers high flow, heated and humidified controlled concentration of oxygen via the nasal route. Recently, its use has increased for a variety of clinical indications. To guide clinical practice, we developed evidence-based recommendations regarding use of HFNC in various clinical settings. Methods: We formed a guideline panel composed of clinicians, methodologists and experts in respiratory medicine. Using GRADE, the panel developed recommendations for four actionable questions. Results: The guideline panel made a strong recommendation for HFNC in hypoxemic respiratory failure compared to conventional oxygen therapy (COT) (moderate certainty), a conditional recommendation for HFNC following extubation (moderate certainty), no recommendation regarding HFNC in the peri-intubation period (moderate certainty), and a conditional recommendation for postoperative HFNC in high risk and/or obese patients following cardiac or thoracic surgery (moderate certainty). Conclusions: This clinical practice guideline synthesizes current best-evidence into four recommendations for HFNC use in patients with hypoxemic respiratory failure, following extubation, in the peri-intubation period, and postoperatively for bedside clinicians.

Original languageEnglish
Pages (from-to)2226-2237
Number of pages12
JournalIntensive Care Medicine
Issue number12
Publication statusPublished - Dec 2020


  • Extubation
  • High flow nasal cannula
  • Mortality
  • Peri-intubation
  • Postoperative
  • Respiratory failure

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