Abstract
High-flow nasal cannula (HFNC) is an open oxygen delivery system, which provides heated and humidified oxygen at a high flow (up to 60 L/min). This effect can improve mucociliary function, airway clearance, and level of comfort to the patient. It can provide controlled and adequate fraction of inspired oxygen (FiO2) between 21% and 100%. Generation of end-expiratory pressure helps in carbon dioxide washout, reduction of anatomical dead space, and recruitment of collapsed alveoli, ultimately improving tissue oxygenation.The use of HFNC in acute hypoxemic respiratory failure, post-extubation period, pre-intubation period, respiratory infection, and obstructive airway disease has been extensively studied, but there are very few studies regarding its use in cardiogenic pulmonary edema. This review provides the current understanding of the physiological effect of HFNC and its application in acute cardiogenic pulmonary edema (ACPE). We conducted a literature search on PubMed using appropriate terms and reviewed relevant articles published within the last 10 years. We found that initial therapy with HFNC in ACPE patients can improve oxygenation and respiratory rate. HFNC can potentially be an alternative to non-invasive positive-pressure ventilation in terms of initial oxygen therapy in patients with ACPE. There is a need for larger prospective studies to evaluate and develop guidelines to consider the use of HFNC in patients with ACPE. We also highlight the fact that if there is no improvement in arterial blood gas parameters after HFNC therapy, initiation of invasive ventilation should not be delayed.
Highlights
BackgroundAcute cardiogenic pulmonary edema (ACPE) is a major and serious complication of acute heart failure
This review provides the current understanding of the physiological effect of High-flow nasal cannula (HFNC) and its application in acute cardiogenic pulmonary edema (ACPE)
It has been thought that a small positive end-expiratory pressure (PEEP) delivered by the system helps in alveolar recruitment and increased oxygenation of tissues [8]
Summary
Acute cardiogenic pulmonary edema (ACPE) is a major and serious complication of acute heart failure. One of the randomized controlled trials by Ko et al compared the use of COT with HFNC in 69 heart failure patients with pulmonary edema presenting to the emergency department (ED) They obtained respiratory rate, oxygen saturation (SpO2), lactate levels and arterial blood gas (ABG) parameters at baseline and 30 and 60 minutes. One of the studies reported that HFNC therapy did not show more benefits compared to COT with respect to endotracheal intubation within 24 hours, intensive care unit admission rate, and 28-day mortality in heart failure patients with acute pulmonary edema [37]. HFNC, high-flow nasal cannula, COT, conventional oxygen therapy; NIPPV, non-invasive positive-pressure ventilation; ABG, arterial blood gas; SpO2, oxygen saturation; PaO2, partial pressure of oxygen; n, number of participants; ACPE, acute cardiogenic pulmonary edema
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