New Guidelines Support High-Flow Nasal Oxygen In Some Hospitalized Patients With Acute Respiratory

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  1. The Good Doctor

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    High-flow nasal oxygen (HFNO) should be considered in hospitalized patients for initial or post-extubation management of acute respiratory failure, the American College of Physicians (ACP) says in a new evidence-based clinical guideline.

    HFNO therapy uses a small nasal cannula to deliver warm humidified oxygen at a flow higher than a patient's normal inspiratory flow.

    "HFNO is relatively new, usage is increasing for hospitalized patients, and comparative benefits and harms of HFNO on clinical outcomes such as mortality, need for intubation, hospital length of stay, patient comfort, etc, are not well known," lead guideline author Dr. Amir Qaseem told Reuters Health by email.

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    "We wanted to a trustworthy clinical guideline to provide recommendations to clinicians based on best available evidence on how to manage hospitalized patients with acute respiratory failure," said ACP's Dr. Qaseem, also of Thomas Jefferson University, in Philadelphia. This is the first ACP guideline on use of HFNO, he noted.

    The ACP clinical guideline is based on a systematic review of the evidence on the benefits and harms of HFNO, taking into account costs and patient values and preferences. The guideline and the review both appear in Annals of Internal Medicine.

    Based on the evidence, the ACP suggests that clinicians use HFNO rather than noninvasive ventilation (NIV) in hospitalized adults for the management of acute hypoxemic respiratory failure. This is a "conditional recommendation" based on "low-certainty evidence."

    "Although the best available evidence at this point is of low certainty and our recommendations are conditional," Dr. Qaseem told Reuters Health, the evidence does indicate that HFNO "reduces mortality, intubations, hospital acquired pneumonia, and improve patient comfort - benefits to consider in most patients when managing acute hypoxemic respiratory failure and it is usually not associated with any contraindications."

    Also, HFNO is cheaper than NIV. "Hence HFNO is preferred over NIV in hospitalized patients to manage acute hypoxemic respiratory failure," he said.

    The ACP guideline also supports HFNO rather than conventional oxygen therapy for hospitalized adults with postextubation acute hypoxemic respiratory failure. This too is a conditional recommendation based on low-certainty evidence.

    In this population, "HFNO reduces re-intubations, improves patient comfort, compared to conventional oxygen therapy, and for other outcomes, is probably as good as conventional oxygen therapy," Dr. Qaseem told Reuters Health.

    This research was funded by the ACP. The authors have no relevant disclosures.

    —Megan Brooks

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