Respiratory failure & ventilation
The effects of flow settings during high-flow nasal cannula support for adult subjects: a systematic review
Authors' conclusion
Individualizing flow settings during HFNC treatment is necessary
Study context
- Population
- Adults receiving high-flow nasal cannula (HFNC) support (in vitro and in vivo studies; pediatric < 18 years and single-flow studies excluded)44 studies
- Comparison
- Different flow settings during HFNC therapy
- Outcome
- Physiological effects of flow settings
Methodological detailsdual independent search, extraction and risk-of-bias assessment, prospectively registered protocol, 32,543 studies identified, PubMed, Embase, Web of Science, Scopus and Cochrane searched for English-language studies before July 10, 2022
- Dual independent search, extraction and risk-of-bias assessment
- Prospectively registered protocol
- 32,543 studies identified
- PubMed, Embase, Web of Science, Scopus and Cochrane searched for English-language studies before July 10, 2022
Pooled result
As reported in the abstract
- In vitro: effects on FiO2, PEEP and CO2 washout are flow-dependent, maximized when flow exceeds patient peak inspiratory flow (varies between patients and disease conditions)
- In vivo: higher flows improve oxygenation and dead space washout and can reduce work of breathing
- Impact of flows on different patients largely heterogeneous
Safety
Adverse effects of higher flows
- Higher flows lead to alveolar overdistention in non-dependent lung regions and patient discomfort
Original publication
The effects of flow settings during high-flow nasal cannula support for adult subjects: a systematic review. Crit Care. Published 28 February 2023. doi:10.
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