High-flow oxygen therapy in pulmonary emergencies

When can we use high-flow oxygen therapy (HFOT) in the emergency management of pulmonary diseases? Do we have any good-quality evidence supporting the use of HFOT in patients without pneumonia?

Jadwiga Wedzicha, MD: High-flow nasal oxygen is interesting because what it actually does is that it provides some PEEP, positive end-expiratory pressure. It is useful where you want to perhaps increase lung volume. In that case we are talking about pneumonia. I think that it is also useful in fibrotic lung disease.

Of course, one has to be careful with hypercapnia; one cannot use it where there is more than borderline hypercapnia. But I think it is particularly useful in fibrotic lung disease, again; there have been meta-analyses where it has been used in intensive care units.

There is not much benefit of high-flow oxygen against standard therapies. But I think the idea is still relatively novel and we will achieve more evidence as we go along.