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High flow nasal cannula (HFNC) as a pillar to aid oxygenation perioperatively: A narrative review

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Review Article

Author Details : Geetanjali T Chilkoti, Michell Gulabani*, Ranajit Chatterjee, Chhavi Sharma, Poonam Sherwat

Volume : 11, Issue : 4, Year : 2024

Article Page : 581-587

https://doi.org/10.18231/j.ijca.2024.103

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Abstract

High flow nasal cannula (HFNC) has gained popularity in recent years as a reliable method to deliver warmed and humidified oxygen at high flows through nasal cannulae. HFNC by virtue of its convenient application, enables compliance and thus is being increasingly used for oxygenation in adult as well pediatric patients. HFNC should ideally be used in a monitored setting such as an intensive care unit, a high-dependency unit and the emergency department. The advantages of HFNC compared with conventional oxygen therapy include delivery of a predictable FiO2, better humidification, decreased anatomical dead space, and improved patient comfort. The concern of aerosol generation with HFNC led to its restricted use during the COVID-19 pandemic. The application of HFNC is multidimensional and ranges from providing respiratory support in the intensive care unit to perioperative use in the operating room (OR) and the post-operative care unit. In the OR, HFNC is used for preoxygenation before tracheal intubation, for apneic oxygenation during laryngoscopy, bronchoscopy, or difficult airway management, for postoperative oxygenation to avoid reintubation and postoperative pulmonary complications (PPC’s). The efficacy of HFNC for postoperative oxygenation has been mainly evaluated in patients following cardiac and thoracic surgery, as they are at risk for development of PPC’s. This review discusses the practical considerations and clinical utilities of HFNC in the perioperative period, including vulnerable patient groups that are the elderly, obese, in patients with an anticipated difficult airway, situations where rapid sequence induction is essential and in patients with the risk of postoperative respiratory failure.
 

Keywords: Non­ invasive ventilation, Oxygen, Nasal cannula, Obese, Elderly, Operating room.

How to cite : Chilkoti G T, Gulabani M, Chatterjee R, Sharma C, Sherwat P, High flow nasal cannula (HFNC) as a pillar to aid oxygenation perioperatively: A narrative review. Indian J Clin Anaesth 2024;11(4):581-587

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