Simon Oczkowski1,2,3, Begüm Ergan4,3, Lieuwe Bos5,6, Michelle Chatwin7, Miguel Ferrer8, Cesare Gregoretti9,10, Leo Heunks11, Jean-Pierre Frat12,13, Federico Longhini14, Stefano Nava15,16, Paolo Navalesi17,18, Aylin Ozsancak Uğurlu19, Lara Pisani15,16, Teresa Renda20, Arnaud W Thille12,13, João Carlos Winck21, Wolfram Windisch22, Thomy Tonia23, Jeanette Boyd24, Giovanni Sotgiu25, Raffaele Scala26. 1. Dept of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada. 2. Dept of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. 3. Co-first authors. 4. Dept of Pulmonary and Critical Care, Dokuz Eylul University School of Medicine, Izmir, Turkey. 5. Dept of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Amsterdam UMC, location Academic Medical Center, Amsterdam, The Netherlands. 6. Respiratory Medicine, Amsterdam UMC, location Academic Medical Center, Amsterdam, The Netherlands. 7. Academic and Clinical Department of Sleep and Breathing and NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK. 8. Dept of Pneumology, Respiratory Institute, Hospital Clinic, IDIBAPS, University of Barcelona and CIBERES, Barcelona, Spain. 9. Dept of Surgical, Oncological and Oral Science, University of Palermo, Palermo, Italy. 10. G. Giglio Institute, Cefalù, Italy. 11. Dept of Intensive Care Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands. 12. Centre Hospitalier Universitaire de Poitiers, Médecine Intensive Réanimation, Poitiers, France. 13. INSERM Centre d'Investigation Clinique 1402 ALIVE, Université de Poitiers, Poitiers, France. 14. Anesthesia and Intensive Care Unit, Dept of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy. 15. Dept of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy. 16. IRCCS Azienda Ospedaliero-Universitaria di Bologna, Respiratory and Critical Care Unit, Bologna, Italy. 17. Department of Medicine - DIMED, University of Padua, Padua, Italy. 18. Anesthesia and Intensive Care, Padua University Hospital, Padua, Italy. 19. Dept of Pulmonary Medicine, Baskent University, Istanbul, Turkey. 20. Cardiothoracic and Vascular Department, Respiratory and Critical Care Unit, Careggi University Hospital, Florence, Italy. 21. Faculdade de Medicina da Universidade do Porto, Porto, Portugal. 22. Dept of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln, gGmbH, Witten/Herdecke University, Faculty of Health/School of Medicine, Köln, Germany. 23. Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland. 24. European Lung Foundation (ELF), Sheffield, UK. 25. Clinical Epidemiology and Medical Statistics Unit, Dept of Medical, Surgical, Experimental Sciences, University of Sassari, Sassari, Italy. 26. Pulmonology and Respiratory Intensive Care Unit, Cardio-Thoraco-Neuro-Vascular Dept, Usl Toscana Sudest, S Donato Hospital, Arezzo, Italy raffaele_scala@hotmail.com.
Abstract
BACKGROUND: High-flow nasal cannula (HFNC) has become a frequently used noninvasive form of respiratory support in acute settings; however, evidence supporting its use has only recently emerged. These guidelines provide evidence-based recommendations for the use of HFNC alongside other noninvasive forms of respiratory support in adults with acute respiratory failure (ARF). MATERIALS AND METHODOLOGY: The European Respiratory Society task force panel included expert clinicians and methodologists in pulmonology and intensive care medicine. The task force used the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methods to summarise evidence and develop clinical recommendations for the use of HFNC alongside conventional oxygen therapy (COT) and noninvasive ventilation (NIV) for the management of adults in acute settings with ARF. RESULTS: The task force developed eight conditional recommendations, suggesting the use of 1) HFNC over COT in hypoxaemic ARF; 2) HFNC over NIV in hypoxaemic ARF; 3) HFNC over COT during breaks from NIV; 4) either HFNC or COT in post-operative patients at low risk of pulmonary complications; 5) either HFNC or NIV in post-operative patients at high risk of pulmonary complications; 6) HFNC over COT in nonsurgical patients at low risk of extubation failure; 7) NIV over HFNC for patients at high risk of extubation failure unless there are relative or absolute contraindications to NIV; and 8) trialling NIV prior to use of HFNC in patients with COPD and hypercapnic ARF. CONCLUSIONS: HFNC is a valuable intervention in adults with ARF. These conditional recommendations can assist clinicians in choosing the most appropriate form of noninvasive respiratory support to provide to patients in different acute settings.
BACKGROUND: High-flow nasal cannula (HFNC) has become a frequently used noninvasive form of respiratory support in acute settings; however, evidence supporting its use has only recently emerged. These guidelines provide evidence-based recommendations for the use of HFNC alongside other noninvasive forms of respiratory support in adults with acute respiratory failure (ARF). MATERIALS AND METHODOLOGY: The European Respiratory Society task force panel included expert clinicians and methodologists in pulmonology and intensive care medicine. The task force used the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methods to summarise evidence and develop clinical recommendations for the use of HFNC alongside conventional oxygen therapy (COT) and noninvasive ventilation (NIV) for the management of adults in acute settings with ARF. RESULTS: The task force developed eight conditional recommendations, suggesting the use of 1) HFNC over COT in hypoxaemic ARF; 2) HFNC over NIV in hypoxaemic ARF; 3) HFNC over COT during breaks from NIV; 4) either HFNC or COT in post-operative patients at low risk of pulmonary complications; 5) either HFNC or NIV in post-operative patients at high risk of pulmonary complications; 6) HFNC over COT in nonsurgical patients at low risk of extubation failure; 7) NIV over HFNC for patients at high risk of extubation failure unless there are relative or absolute contraindications to NIV; and 8) trialling NIV prior to use of HFNC in patients with COPD and hypercapnic ARF. CONCLUSIONS: HFNC is a valuable intervention in adults with ARF. These conditional recommendations can assist clinicians in choosing the most appropriate form of noninvasive respiratory support to provide to patients in different acute settings.
Authors: Maciej Dyrbuś; Aleksandra Oraczewska; Szymon Szmigiel; Szymon Gawęda; Paulina Kluszczyk; Tomasz Cyzowski; Marek Jędrzejek; Paweł Dubik; Michał Kozłowski; Sebastian Kwiatek; Beata Celińska; Michał Wita; Ewa Trejnowska; Andrzej Swinarew; Tomasz Darocha; Adam Barczyk; Szymon Skoczyński Journal: J Clin Med Date: 2022-05-24 Impact factor: 4.964
Authors: Pieter Veenstra; Nic J G M Veeger; Ralph J H Koppers; Marieke L Duiverman; Wouter H van Geffen Journal: PLoS One Date: 2022-10-05 Impact factor: 3.752
Authors: Barbara Bonnesen; Jens-Ulrik Stæhr Jensen; Klaus Nielsen Jeschke; Alexander G Mathioudakis; Alexandru Corlateanu; Ejvind Frausing Hansen; Ulla Møller Weinreich; Ole Hilberg; Pradeesh Sivapalan Journal: Diagnostics (Basel) Date: 2021-12-02