ICU · Respiratory

Oxygen therapy and high-flow nasal cannula in acute respiratory failure

Also known as Oxygen therapy · High-flow nasal cannula · HFNC · Optiflow · Airvo · FLORALI · Nasal high flow

Oxygen therapy in acute respiratory failure: escalating from low-flow (nasal cannula, simple mask) to HIGH-FLOW NASAL CANNULA (HFNC) to non-invasive ventilation (NIV) to invasive mechanical ventilation. HFNC: heated, humidified oxygen at HIGH flow (30-60 L/min) via nasal cannula. Benefits: (1) FiO2 precisely controlled (21-100%). (2) LOW-LEVEL PEEP (3-5 cmH2O — washout dead space, alveolar recruitment). (3) Heated/humidified (better mucociliary clearance, comfort). (4) Reduced work of breathing. FLORALI trial: HFNC reduced intubation vs NIV/standard in hypoxic respiratory failure (PaO2/FiO2 <300). Indications: pneumonia, COVID-19, cardiogenic pulmonary oedema, post-extubation, immunocompromised. Failures → intubate (don't delay).