Appropriate use of high-flow nasal oxygen in hospitalised patients for initial or postextubation management of acute respiratory failure: A clinical guideline from the American College of Physicians

This US guideline provides clinical recommendations on the appropriate use of high-flow nasal oxygen (HFNO) in hospitalised patients. It is based on the best available evidence on the benefits and harms of HFNO, taken in the context of costs and patient values and preferences.

SPS commentary:

The review upon which this guidance is based includes 29 RCT’s which found high-flow nasal oxygen (HFNO) when compared with NIV as initial acute respiratory failure management may improve several clinical outcomes. Compared with conventional oxygen therapy (COT), HFNO as postextubation management may reduce reintubations and improve patient comfort; HFNO resulted in fewer harms than NIV or COT. Broad applicability, including required clinician and health system experience and resource use, is not well known.

Annals of Internal Medicine

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Review evidence