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Supplemental oxygen therapy is one of the more commonly prescribed interventions used by clinicians when caring for hypoxic patients acutely. This supplementation often takes the form of a low-flow nasal cannula (LFNC). However, there are limitations to this supplemental oxygen intervention. A traditional nasal cannula can only effectively provide only up to 4 to 6 liters per minute of supplemental oxygen. This equates to a FiO2 of approximately 0.37 to 0.45. Above this number, nasal mucosal irritation occurs with the drying of the passages, and there is, therefore, an increased potential for bleeding with prolonged use. In low-flow nasal cannula therapy, FiO2 delivery is directly tied to flow rate. For increased FiO2, the rate must be increased. The low-flow nasal cannula is an open system of supplementation with high levels of leaking air around the oxygen source. As such, the efficacy of treatment for the low-flow nasal cannula is limited. High-flow nasal cannula (HFNC) therapy is an oxygen supply system capable of delivering up to 100% humidified and heated oxygen at a flow rate of up to 60 liters per minute. All settings are controlled independently, allowing for greater confidence in the delivery of supplemental oxygen as well as better outcomes when used. In addition to greater control over the delivery of FiO2, there are several benefits to using a high-flow nasal cannula. The physiological mechanism of action and uses for high-flow nasal cannula are explored. This activity reviews the use of a high flow nasal cannula and the role of the interprofessional team in evaluating and monitoring patients receiving high flow oxygen. Objectives: Describe the limitations to low-flow nasal cannula use. Identify the advantages of high-flow nasal cannula use. Review the physiological mechanism of action and the use of high-flow use of a nasal cannula. Outline the use of a high flow nasal cannula and the role of the interprofessional team in evaluating and monitoring patients receiving high flow oxygen. Access free multiple choice questions on this topic.

Supplemental oxygen therapy is one of the more commonly prescribed interventions used by physicians when caring for hypoxic patients acutely. This supplementation often takes the form of a low-flow nasal cannula (LFNC). However, there are limitations to this supplemental oxygen intervention. A traditional nasal cannula can only effectively provide only up to 4 to 6 liters per minute of supplemental oxygen. This equates to a FiO2 of approximately 0.37 to 0.45. Above this number, nasal mucosal irritation occurs with the drying of the passages, and there is, therefore, an increased potential for bleeding with prolonged use. In low-flow nasal cannula therapy, FiO2 delivery is directly tied to flow rate. For increased FiO2, the rate must be increased. The low-flow nasal cannula is an open system of supplementation with high levels of leaking air around the oxygen source. As such, the efficacy of treatment for the low-flow nasal cannula is limited. High-flow nasal cannula (HFNC) therapy is an oxygen supply system capable of delivering up to 100% humidified and heated oxygen at a flow rate of up to 60 liters per minute. All settings are controlled independently, allowing for greater confidence in the delivery of supplemental oxygen as well as better outcomes when used. In addition to greater control over the delivery of FiO2, there are several benefits to using a high-flow nasal cannula. The physiological mechanism of action and uses for high-flow nasal cannula are explored here.[1][2]

High-flow nasal cannula therapy is a relatively new treatment, and not everyone is familiar with the equipment. Educational sessions should be held for nurses, respiratory therapists, and other clinicians before the treatment is introduced in the hospital. A collaborative interprofessional team comprised of a respiratory therapist, the clinical or critical care nurse, and a medical provider can greatly improve patient outcomes when undergoing high-flow nasal cannula therapy. The bedside nurse can assist the medical team by monitor the patient's vital signs and respiratory effort while on high-flow therapy to ensure there is no risk of impending respiratory compromise. The respiratory therapist can titrate the flow and oxygen percentage to meet the patient's needs and decrease the risk of over oxygenation or barotrauma. Communicating the efficacy of high-flow nasal cannula with the medical provider or the need for a higher level of respiratory support when needed, the nurses and respiratory therapists can enhance healthcare outcomes by notification of the medical team leading to timely adjustments for the patient. [Level 5]