RT Journal Article
SR Electronic
T1 ERS Clinical Practice Guidelines: high-flow nasal cannula in acute respiratory failure
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 2101574
DO 10.1183/13993003.01574-2021
A1 Simon Oczkowski
A1 Begüm Ergan
A1 Lieuwe Bos
A1 Michelle Chatwin
A1 Miguel Ferrer
A1 Cesare Gregoretti
A1 Leo Heunks
A1 Jean-Pierre Frat
A1 Federico Longhini
A1 Stefano Nava
A1 Paolo Navalesi
A1 Aylin Ozsancak Uğurlu
A1 Lara Pisani
A1 Teresa Renda
A1 Arnaud W. Thille
A1 João Carlos Winck
A1 Wolfram Windisch
A1 Thomy Tonia
A1 Jeanette Boyd
A1 Giovanni Sotgiu
A1 Raffaele Scala
YR 2021
UL http://erj.ersjournals.com/content/early/2021/09/29/13993003.01574-2021.abstract
AB Background High-flow nasal cannula (HFNC) has become a frequently used non-invasive 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 Evaluations) methods to summarise evidence and develop clinical recommendations for the use of HFNC alongside conventional oxygen therapy (COT) and non-invasive ventilation (NIV) for the management of adults in acute settings with ARF.Results The Task Force developed 8 conditional recommendations, suggesting using: 1) HFNC over COT in hypoxemic ARF, 2) HFNC over NIV in hypoxemic 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 non-surgical 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, 8) trialling NIV prior to use of HFNC in patients with chronic obstructive pulmonary disease (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 non-invasive respiratory support to provide to patients in different acute settings.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Simon Oczkowski reports support for the current manuscript from Librarian support services; support for attending meetings and/or travel from ERS, European Society of Intensive Care Medicine, Society of Critical Care Medicine, outside the submitted work.Conflict of interest: Begüm Ergan has nothing to disclose.Conflict of interest: Lieuwe Bos reports grants from the Dutch lung foundation (Young investigator grant), grants from the Dutch lung foundation and Health Holland (Public-Private Partnership grant), grants from the Dutch lung foundation (Dirkje Postma Award), grants from IMI COVID19 initiative, grants from Amsterdam UMC fellowship, outside the submitted work.Conflict of interest: Michelle Chatwin reports lecture fees from ResMed UK, Breas Medical UK, MPR Italy; and since December 2020 has worked part time for Breas Medical as their global clinical specialist, including CAB membership and support for attending meetings and/or travel.Conflict of interest: Miguel Ferrer has nothing to disclose.Conflict of interest: Cesare Gregoretti reports consulting fees from Mindray, Air Liquide; lecture fees from Vivisol, Philips, Air Liquide; support for attending meetings and/or travel from Fisher & Paykel; outside the submitted work.Conflict of interest: Leo Heunks reports grants from InflaRx; consulting fees from Liberate Medical, USA; speaker fees from Fisher & Paykel, Maquet; outside the submitted work.Conflict of interest: Jean-Pierre Frat reports funding, provision of study materials, personal fees for lectures, travels and accommodations expenses reimbursement from Fisher and Paykel Healthcare; personal fees as a member of a scientific board from SOS oxygene; grants from French Ministry of health; outside the submitted work.Conflict of interest: Federico Longhini reports honoraria for a lecture from Draeger; Issued patent for a new device for non-invasive ventilation (European patent n° 3320941) from Intersurgical SPA; outside the submitted work.Conflict of interest: Stefano Nava has nothing to disclose.Conflict of interest: Paolo Navalesi has nothing to disclose.Conflict of interest: Aylin Ozsancak Uğurlu has nothing to disclose.Conflict of interest: Lara Pisani has nothing to disclose.Conflict of interest: Teresa Renda has nothing to disclose.Conflict of interest: Arnaud Thille reports payments for lectures and upport for attending meetings and/or travel from Fisher&Paykel; Fisher & Paykel provided the high-flow nasal oxygen equipment and masks for NIV in several randomised clinical trials coordinated by our center.Conflict of interest: João Carlos Winck reports webinar fees from Armstrong Medical, Breas, Philips, Nippon Gases; outside the submitted work.Conflict of interest: Wolfram Windisch reports grants from Philips/Respironics/USA, Löwenstein Medical/Germany, VitalAire/Germany, Vivisol/Germany; speaking fees from Philips/Respironics/USA, Löwenstein Medical/Germany, VitalAire/Germany; outside the submitted work.Conflict of interest: Thomy Tonia acts as ERS Methodologist.Conflict of interest: Jeanette Boyd has nothing to disclose.Conflict of interest: Giovanni Sotgiu has nothing to disclose.Conflict of interest: Raffaele Scala has nothing to disclose.