Anaesthetics Changing practice Emergency

Peri-intubation High Flow Nasal Oxygen

C – Clinical practice

Use of high flow nasal cannulae oxygen for pre-oxygenation and apnoiec oxygenation

H – How/where/why?

For a patient requiring assisted ventilation, the addition of high flow oxygen through nasal cannulae underneath the face mask is thought to increase functional residual capacity and possibly reduce some of the risks associated with intubation.  Non-humidified, direct wall or tank oxygen is most commonly used for this purpose as opposed to humidified oxygen through a portable high flow system which is also used for longer term therapeutics such as in paediatric respiratory distress or COPD.

A – Affecting who?

Rural generalists, Emergency doctors and Anaesthetists.

N – New or old?

Not included in many circulating guidelines but reportedly in widespread recent practice.

G – Good or bad?

Still controversial, however may be useful for streamlining the intubation process for operators and reducing intubation risks for patients.

E – Evidence

THRIVE study

Patel A, Nouraei SA. Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE): a physiological method of increasing apnoea time in patients with difficult airways. Anaesthesia. 2015;70:(3)323-9.

FLORALI study

Frat JP, Thille AW, Mercat A, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med. 2015;372:(23)2185-96.

Preoxygenation, Reoxygenation and Deoxygenation

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