What is high-flow nasal cannula (HFNC)?

High-flow nasal cannula (HFNC), also referred to as nasal high flow (NHF), is a therapy that has gained traction in the past decade and is sometimes lumped together with the use of noninvasive ventilation (NIV). Since it differs from noninvasive ventilation, it will be important to highlight differences between these two therapies.

Let’s take a moment to remember the traditional nasal cannula. When connected to wall oxygen, this cannula can deliver oxygen at flow rates from 1 to 6 L / min for extended periods of time. Higher flow rates are not well tolerated due to nasal irritation and discomfort.

High-flow nasal cannula, or HFNC, is a system that allows oxygen to be delivered to patients at very high flow rates. In adults, it can be titrated from 20 L / min up to 60 L / min! By using specialized nasal cannulas, heating the circuit to body temperature and humidifying the air, these high rates can be delivered with very good patient tolerance.

Like the flow rate, fraction of inspired oxygen (F_IO₂) can be precisely titrated as well. An air-oxygen blender can take 100% wall oxygen, mix it with room air, and deliver a F_IO₂ between 21 and 100%.

HFNC is similar to NIV in that it reduces the entrainment of room air and allows a more precise amount of oxygen to be delivered. It requires a specialized interface that sits in the nose with larger bore openings. It can provide respiratory support to patients with respiratory failure due to hypoxia.

HFNC differs to NIV in that it provides less ventilatory support. You set a flow rate instead of setting inspiratory and expiratory pressures. Therefore, the pressure produced from HFNC flow rates is much lower in comparison to NIV.

Do not use high-flow nasal cannula, or HFNC, in patients with:

• Ventilatory failure
• Hypercapnia

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