COVID-19, caused by SARS-CoV-2 infection, led to a pandemic of acute respiratory illness that is ongoing. High-flow nasal cannula (HFNC) is a commonly used form of respiratory support during acute respiratory distress and is used to treat patients with COVID-19 in many centers. Due to the novel nature of COVID-19 at the onset of the pandemic, evidence to support the use and best practices of HFNC for treating patients with COVID-19 was lacking. This is a review of key peer-reviewed manuscripts from 2022–2023 discussing the efficacy and best practices for using HFNC for patients with COVID-19. Efficacy of HFNC for COVID-19, the use of the respiratory oxygenation index to guide HFNC for COVID-19, and concerns of generated/fugitive aerosols when using HFNC for COVID-19 are emphasized.
GlenardiG, ChriestyaF, OetoroBJ, MangkuligunaG, NataliaN. Comparison of high-flow nasal oxygen therapy and noninvasive ventilation in COVID-19 patients: a systematic review and meta-analysis. Acute Crit Care, 2022; 37(1):71-83.
3.
LiY, LiC, ChangW, LiuL. High-flow nasal cannula reduces intubation rate in patients with COVID-19 with acute respiratory failure: a meta-analysis and systematic review. BMJ Open, 2023; 13(3):e067879.
4.
ArrudaDG, KielingGA, Melo-DiazLL. Effectiveness of high-flow nasal cannula therapy on clinical outcomes in adults with COVID-19: a systematic review. Can J Respir Ther, 2023; 59:52-65.
5.
CrimiC, PierucciP, RendaT, PisaniL, CarlucciA. High-flow nasal cannula and COVID-19: a clinical review. Respir Care, 2022; 67(2):227-240.
6.
RaboniSM, NevesVC, SilvaRM, BredaGL, CeregatoAC, BrozaTP, et al. High-flow nasal cannula therapy in patients with COVID-19: predictive response factors. Respir Care, 2022; 67(11):1443-1451.
7.
PhanAV, HoangHT, Truong DoTS, HoangTQ, PhanTV, HuynhNP, Minh LeK. High-flow nasal cannula therapy in patients with COVID-19 in intensive care units in a country with limited resources: a single-center experience. J Int Med Res, 2023; 51(8):3000605231193580.
8.
YauCE, LeeDYX, VasudevanA, GohKJ, WongE, HoAFW, LimDYZ. Performance of the ROX index in predicting high-flow nasal cannula failure in COVID-19 patients: a systematic review and meta-analysis. Crit Care, 2023; 27(1):320.
9.
HirabayashiR, NagataK, SatoY, NakagawaA, TachikawaR, KurodaH, et al. Reliability of the respiratory rate and oxygenation index for successful high-flow nasal cannula support in coronavirus disease pneumonia: a retrospective cohort study. BMC Pulm Med, 2023; 23(1):294.
10.
AbrougF, HammoudaZ, LahmarM, NouiraW, MaatoukS, YoussefSB, et al. Early variation of ROX index predicts high-flow nasal cannula outcome in awake subjects with severe hypoxemic COVID-19. Respir Care, 2023; 68(1):110-113.
11.
OkazakiY, NishikimiM, IshiiJ, OtaK, OhshimoS, ShimeN. Predictive accuracy of the ROX index for re-intubation in mechanically ventilated patients with COVID-19. Respir Care, 2023; 68(8):1067-1074.
12.
AdirY, SegolO, KompanietsD, ZisoH, YaffeY, BergmanI, et al. COVID-19: minimizing risk to health care workers during aerosol-producing respiratory therapy using an innovative constant flow canopy. Eur Respir J, 2020; 55(5).
13.
AgarwalA, BasmajiJ, MuttalibF, GrantonD, ChaudhuriD, ChetanD, et al. High-flow nasal cannula for acute hypoxemic respiratory failure in patients with COVID-19: systematic reviews of effectiveness and its risks of aerosolization, dispersion, and infection transmission. Can J Anaesth, 2020; 67(9):1217-1248.
14.
BengeCD, BarwiseJA. Aerosolization of COVID-19 and contamination risks during respiratory treatments. Fed Pract, 2020; 37(4):160-163.
15.
CazzolaM, OraJ, BiancoA, RoglianiP, MateraMG. Guidance on nebulization during the current COVID-19 pandemic. Respir Med, 2021; 176:106236.
16.
LiJ, AlolaiwatAA, HarnoisLJ, FinkJB, DhandR. Mitigating fugitive aerosols during aerosol delivery via high-flow nasal cannula devices. Respir Care, 2022; 67(4):404-414.
17.
RamseyME, FaugnoAJ, PuryearWB, LeeBC, FossAD, LambertLH, et al. Characterization of SARS-CoV-2 aerosols dispersed during noninvasive respiratory support of patients with COVID-19. Respir Care, 2023; 68(1):8-17.
18.
ParkeRL, EcclestonML, McGuinnessSP. The effects of flow on airway pressure during nasal high-flow oxygen therapy. Respir Care, 2011; 56(8):1151-1155.
19.
KilgourE, RankinN, RyanS, PackR. Mucociliary function deteriorates in the clinical range of inspired air temperature and humidity. Intensive Care Med, 2004; 30(7):1491-1494.
20.
ChidekelA, ZhuY, WangJ, MoskoJJ, RodriguezE, ShafferTH. The effects of gas humidification with high-flow nasal cannula on cultured human airway epithelial cells. Pulm Med, 2012; 2012:380686.
21.
DelormeM, BouchardP-A, SimonM, SimardS, LelloucheF. Effects of high-flow nasal cannula on the work of breathing in patients recovering from acute respiratory failure. Crit Care Med, 2017; 45(12):1981-1988.
22.
MauriT, AlbanL, TurriniC, CambiaghiB, CarlessoE, TacconeP, et al. Optimum support by high-flow nasal cannula in acute hypoxemic respiratory failure: effects of increasing flow rates. Intensive Care Med, 2017; 43(10):1453-1463.
23.
MotoyasuA, MoriyamaK, OkanoH, YorozuT. High-flow nasal cannula therapy reduced the respiratory rate and respiratory distress in a standard model simulator and in patients with hypoxemic respiratory failure. Chron Respir Dis, 2019; 16:1479973119880892.
24.
ParkeRL, McGuinnessSP. Pressures delivered by nasal high-flow oxygen during all phases of the respiratory cycle. Respir Care, 2013; 58(10):1621-1624.
25.
GrovesN, TobinA. High-flow nasal oxygen generates positive airway pressure in adult volunteers. Aust Crit Care, 2007; 20(4):126-131.
26.
RitchieJE, WilliamsAB, GerardC, HockeyH. Evaluation of a humidified nasal high-flow oxygen system, using oxygraphy, capnography, and measurement of upper-airway pressures. Anaesth Intensive Care, 2011; 39(6):1103-1110.
27.
CorleyA, CaruanaLR, BarnettAG, TronstadO, FraserJF. Oxygen delivery through high-flow nasal cannula increase end-expiratory lung volume and reduce respiratory rate in post–cardiac surgical patients. Br J Anaesth, 2011; 107(6):998-1004.
28.
MündelT, FengS, TatkovS, SchneiderH. Mechanisms of nasal high flow on ventilation during wakefulness and sleep. J Appl Physiol (1985), 2013; 114(8):1058-1065.
29.
MöllerW, FengS, DomanskiU, FrankeK-J, CelikG, BartensteinP, et al. Nasal high flow reduces dead space. J Appl Physiol (1985), 2017; 122(1):191-197.
