High-flow nasal oxygen in anesthesiology practice

Hypoxemia is an important complication of general anesthesia and procedural sedation and is associated with cardiopulmonary complications, increased hospital length of stay, and increased mortality. Through this Continuing Professional Development module, we aim to guide anesthesiologists in the safe use of high-flow nasal oxygen (HFNO). It examines the potential advantages and limitations of HFNO across the spectrum of anesthesiology practice, from procedural sedation to airway management, highlighting its role in enhancing patient safety.

High-flow nasal oxygen is a noninvasive respiratory support modality capable of delivering high flow rates and oxygen concentrations to patients during spontaneous breathing and apneic periods. Its efficacy depends on airway patency and on whether a patient's mouth is open or closed. Although HFNO can improve oxygenation and potentially prolong safe apnea times during airway management, clinicians must be aware of risks, such as progressive hypercapnia during prolonged apneic periods.

Key advantages of HFNO include ease of application, the delivery of high inspired oxygen fractions and flow rates, and the potential generation of continuous positive airway pressure. For specific patient populations, HFNO can enhance respiratory support and safety throughout diverse perioperative situations.