High-flow nasal oxygen therapy in acute respiratory failure

High-flow nasal cannula (HFNC) is a new effective device, which is able to deliver oxygen-therapy at a reliable FiO₂ but also a certain amount of respiratory assistance; however HFNC could not be defined as a mechanical ventilator. The main physiologic advantage as compared to conventional oxygen therapy (COT) is the capability of HFNC to meet the increased ventilator demand in patients with respiratory distress and therefore reduce the amount of respiratory muscle’s workload. The main clinical advantage over both COT and noninvasive ventilation (NIV) is the greater comfort and acceptability reported by patients. So far there are several indications for HFNC use both in and outside ICU especially for milder hypoxemic spontaneously breathing patients and prevention of extubation failure in intubated patients, as well as palliative care in end stage neoplastic and nonneoplastic respiratory diseases. A large proportion of potential HFNC candidates belongs to advanced age people. Caution should be taken in the selection of the patients, monitoring, escalating treatment and setting of aplication.