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Minerva Medica 2016 December;107(6 Suppl 1):14-20


lingua: Inglese

High flow nasal cannula oxygen therapy, work in progress in respiratory critical care

Annia SCHREIBER 1, Fabiano DI MARCO 2, Fulvio BRAIDO 3, Paolo SOLIDORO 4

1 Respiratory Intensive Care Unit and Pulmonary Rehabilitation Unit, Salvatore Maugeri Foundation, Pavia, Italy; 2 Unit of Pneumology, Department of Health Sciences, Università degli Studi di Milano, San Paolo Hospital, Milan, Italy; 3 Allergy and Respiratory Diseases Unit, Department of Internal Medicine (DIMI), IRCCS San Martino di Genova University Hospital, Genoa, Italy; 4 Unit of Pneumology, Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza di Torino, University Hospital, Turin, Italy


After a planned extubation, the re-occurrence of acute respiratory distress needing the restoration of invasive mechanical support is a severe phenomenon associated with several important consequences, including increased morbidity, Intensive Care Unit mortality, and an enormous financial burden. So far, the most commonly used techniques to ameliorate gas exchange in the postextubation period were low-flow oxygen therapy and non-invasive ventilation (NIV). High flows through nasal cannulae (HFNC) is a system which allows increased CO2 wash-out of anatomical dead space, positive nasopharyngeal pressure, a relatively constant FiO2, and an improvement of mucociliary function. In a recently published paper by Hernandez et al. HFNC therapy, compared in the postextubation period to standard oxygen in patients at low risk of re-intubation, was associated with a lower re-intubation rate within 72 hours of extubation, with no evidence of any delays in re-intubation which may prove fatal, as previously reported in the context of NIV. Despite yielding some useful starting points and positive results with HFNC, some discrepancies have emerged in the findings of the studies in this field. As we await further more homogeneous and enlightening studies, at present we can only affirm that HFNC seems to be a useful means to prevent and treat postextubation hypoxemia. In fact no harmful or adverse effects related to HFNC emerged in any of the studies and globally, it was associated with better comfort and tolerance compared with NIV, which justifies its use as a first alternative to standard oxygen therapy.

KEY WORDS: Oxygen inhalation therapy - Catheters - Respiration, artificial

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