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November 27, 2018

High-Flow Nasal Oxygen—The Pendulum Continues to Swing in the Assessment of Critical Care Technology

Author Affiliations
  • 1Department of Medicine, University of Chicago, Chicago, Illinois
  • 2Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois
  • 3University of Chicago, Chicago, Illinois
JAMA. 2018;320(20):2083-2084. doi:10.1001/jama.2018.14287

Standard oxygen by mask or nasal prongs has been the first-line therapy for patients with acute hypoxemic respiratory failure (AHRF), followed by intubation to provide invasive mechanical ventilation for patients for whom this approach has failed. Although intubation and subsequent invasive mechanical ventilation can be lifesaving, these procedures are associated with many complications1 and some patients with comorbidities—for example, those who are immunosuppressed—have disproportionately high morbidity and mortality.2 Two technologies have been developed to bridge the therapy gap between standard oxygen therapy and invasive mechanical ventilation: noninvasive ventilation (NIV) and high-flow nasal oxygen therapy. Although there is controversy about how these technologies fit in the management of AHRF, they share a similar proliferation based on early enthusiasm followed by widespread adoption and over time a tempering of expectations related to ongoing evaluation in randomized clinical trials.