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Related Experiment Video

Updated: Feb 17, 2026

Preoxygenation Techniques for Tracheal Intubation in Critically Ill Adults Utilizing Oxygen Mask and Noninvasive Ventilation
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Preoxygenation Techniques for Tracheal Intubation in Critically Ill Adults Utilizing Oxygen Mask and Noninvasive Ventilation

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Proactive Use of High-Flow Nasal Cannula With Critically Ill Subjects.

Keith D Lamb1,2, Sarah K Spilman3, Trevor W Oetting1

  • 1Department of Respiratory Therapy, UnityPoint Health, Des Moines, Iowa.

Respiratory Care
|December 7, 2017
PubMed
Summary

Protocolized high-flow nasal cannula (HFNC) use reduced pulmonary infections and bronchodilator use when extubating patients. Early HFNC initiation also decreased ICU and hospital length of stay in acute hypoxic respiratory failure patients.

Keywords:
high-flow nasal cannulamechanical ventilationpostextubation managementpulmonary infectionre-intubationrespiratory failure

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Area of Science:

  • Critical Care Medicine
  • Respiratory Therapy
  • Pulmonology

Background:

  • High-flow nasal cannula (HFNC) is a potential first-line therapy for acute hypoxic respiratory failure.
  • Investigating protocolized HFNC use to reduce unplanned intubation and adverse outcomes in ICU patients is crucial.

Purpose of the Study:

  • To evaluate the impact of protocolized high-flow nasal cannula (HFNC) use on unplanned intubation rates.
  • To assess the effect of protocolized HFNC on adverse outcomes in intensive care unit (ICU) populations.

Main Methods:

  • Prospective evaluation of two cohorts receiving HFNC per protocol.
  • Comparison with retrospective control groups from the pre-protocol period.
  • Cohort 1: Extubation to HFNC after mechanical ventilation (n=88). Cohort 2: Early HFNC initiation for escalating oxygen needs (n=83).

Main Results:

  • Cohort 1 showed decreased Gram-negative pulmonary infections and bronchodilator use, but no change in mortality or length of stay.
  • Cohort 2 demonstrated reduced ICU and hospital length of stay with early, protocolized HFNC initiation.
  • No significant differences in mortality or intubation rates were observed between protocolized and control groups.

Conclusions:

  • Extubation to HFNC significantly reduced pulmonary infections and bronchodilator therapy but did not impact length of stay or failed extubation rates.
  • Early, protocolized HFNC initiation in ICU patients with acute hypoxic respiratory failure led to shorter ICU and hospital stays.
  • Protocol adherence for HFNC use warrants further investigation for optimizing patient outcomes in respiratory failure.