Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
권호 표지
DOI QR코드

DOI QR Code

Home High-Flow Nasal Cannula in Patients with Chronic Respiratory Failure: A Literature Review and Suggestions for Clinical Practice

  • Youjin Chang (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine) ;
  • Moon Seong Baek (Department of Internal Medicine, Chung-Ang University College of Medicine) ;
  • Sei Won Kim (Department of Pulmonary, Critical Care and Sleep Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Su Hwan Lee (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine) ;
  • Jung Soo Kim (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inha University Hospital) ;
  • So Young Park (Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital) ;
  • Jin Woo Kim (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Jae Hwa Cho (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Sunghoon Park (Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital)
  • Received : 2024.12.22
  • Accepted : 2025.02.12
  • Published : 2025.04.30
Download PDF
⟨ Previous Next ⟩

Abstract

High-flow nasal cannula (HFNC) is a noninvasive respiratory support system that delivers air that is heated at 31℃-38℃, humidified 100%, and oxygen-enriched at a constant high flow rate of 15-60 L/min. Because of its numerous physiological benefits, convenience, and minimal side effects, HFNC has been increasingly used over the past decade in patients with acute hypoxemic respiratory failure, yet the clinical benefits of long-term HFNC remain uncertain. Several studies have suggested its potential use as an alternative home oxygen therapy for patients with chronic stable lung diseases, such as chronic obstructive pulmonary disease (COPD), interstitial lung disease, and bronchiectasis. The use of long-term home HFNC in patients with chronic respiratory failure is an emerging area with promising potential. Despite limited clinical research, this review aims to describe the physiology of HFNC use and summarize the current evidence on its long-term application, to provide healthcare providers with insights and perspectives on the potential role of long-term home HFNC.

Keywords

Acknowledgement

We wish to thankTai Sun Park (Hanyang University Guri Hospital), Ae-Rin Baek (Soonchunhyang University Bucheon Hospital), Jick Hwan Ha (Incheon St. Mary's Hospital), and Hyonsoo Joo (Uijeongbu St. Mary's Hospital) for their assistance in data collection and interpretation.

References

  1. Choudhury R. Hypoxia and hyperbaric oxygen therapy: a review. Int J Gen Med 2018;11:431-42. https://doi.org/10.2147/IJGM.S172460
  2. O'Driscoll BR, Howard LS, Earis J, Mak V. British Thoracic Society guideline for oxygen use in adults in healthcare and emergency settings. BMJ Open Respir Res 2017;4:e000170. https://doi.org/10.1136/bmjresp-2016-000170
  3. Spicuzza L, Schisano M. High-flow nasal cannula oxygen therapy as an emerging option for respiratory failure: the present and the future. Ther Adv Chronic Dis 2020;11:2040622320920106. https://doi.org/10.1177/2040622320920106
  4. Frat JP, Thille AW, Mercat A, Girault C, Ragot S, Perbet S, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med 2015;372:2185-96. https://doi.org/10.1056/NEJMoa1503326
  5. Jacome C, Jacome M, Correia S, Flores I, Farinha P, Duarte M, et al. Effectiveness, adherence and safety of home high flow nasal cannula in chronic respiratory disease and respiratory insufficiency: a systematic review. Arch Bronconeumol 2024;60:490-502. https://doi.org/10.1016/j.arbres.2024.05.001
  6. Oczkowski S, Ergan B, Bos L, Chatwin M, Ferrer M, Gregoretti C, et al. ERS clinical practice guidelines: high-flow nasal cannula in acute respiratory failure. Eur Respir J 2022;59:2101574. https://doi.org/10.1183/13993003.01574-2021
  7. Rochwerg B, Einav S, Chaudhuri D, Mancebo J, Mauri T, Helviz Y, et al. The role for high flow nasal cannula as a respiratory support strategy in adults: a clinical practice guideline. Intensive Care Med 2020;46:2226-37. https://doi.org/10.1007/s00134-020-06312-y
  8. Rochwerg B, Brochard L, Elliott MW, Hess D, Hill NS, Nava S, et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J 2017;50:1602426. https://doi.org/10.1183/13993003.02426-2016
  9. Jacobs SS, Krishnan JA, Lederer DJ, Ghazipura M, Hossain T, Tan AM, et al. Home oxygen therapy for adults with chronic lung disease: an official American Thoracic Society clinical practice guideline. Am J Respir Crit Care Med 2020;202:e121-41. https://doi.org/10.1164/rccm.202009-3608ST
  10. Rea H, McAuley S, Jayaram L, Garrett J, Hockey H, Storey L, et al. The clinical utility of long-term humidification therapy in chronic airway disease. Respir Med 2010;104:525-33. https://doi.org/10.1016/j.rmed.2009.12.016
  11. Sorensen SS, Storgaard LH, Weinreich UM. Cost-effectiveness of domiciliary high flow nasal cannula treatment in COPD patients with chronic respiratory failure. Clinicoecon Outcomes Res 2021;13:553-64. https://doi.org/10.2147/CEOR.S312523
  12. Maggiore SM, Jaber S, Grieco DL, Mancebo J, Zakynthinos S, Demoule A, et al. High-flow versus venturimask oxygen therapy to prevent reintubation in hypoxemic patients after extubation: a multicenter randomized clinical trial. Am J Respir Crit Care Med 2022;206:1452-62. https://doi.org/10.1164/rccm.202201-0065OC
  13. Bonnevie T, Elkins M, Paumier C, Medrinal C, Combret Y, Patout M, et al. Nasal high flow for stable patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. COPD 2019;16:368-77. https://doi.org/10.1080/15412555.2019.1672637
  14. Duan L, Xie C, Zhao N. Effect of high-flow nasal cannula oxygen therapy in patients with chronic obstructive pulmonary disease: a meta-analysis. J Clin Nurs 2022;31:87-98. https://doi.org/10.1111/jocn.15957
  15. Yang H, Huang D, Luo J, Liang Z, Li J. The use of highflow nasal cannula in patients with chronic obstructive pulmonary disease under exacerbation and stable phases: a systematic review and meta-analysis. Heart Lung 2023;60:116-26.
  16. Nagata K, Kikuchi T, Horie T, Shiraki A, Kitajima T, Kadowaki T, et al. Domiciliary high-flow nasal cannula oxygen therapy for patients with stable hypercapnic chronic obstructive pulmonary disease: a multicenter randomized crossover trial. Ann Am Thorac Soc 2018;15:432-9. https://doi.org/10.1513/AnnalsATS.201706-425OC
  17. Nagata K, Horie T, Chohnabayashi N, Jinta T, Tsugitomi R, Shiraki A, et al. Home high-flow nasal cannula oxygen therapy for stable hypercapnic COPD: a randomized clinical trial. Am J Respir Crit Care Med 2022;206:1326-35. https://doi.org/10.1164/rccm.202201-0199OC
  18. Storgaard LH, Hockey HU, Laursen BS, Weinreich UM. Long-term effects of oxygen-enriched high-flow nasal cannula treatment in COPD patients with chronic hypoxemic respiratory failure. Int J Chron Obstruct Pulmon Dis 2018;13:1195-205. https://doi.org/10.2147/COPD.S159666
  19. Storgaard LH, Hockey HU, Weinreich UM. Development in PaCO2 over 12 months in patients with COPD with persistent hypercapnic respiratory failure treated with high-flow nasal cannula-post-hoc analysis from a randomized controlled trial. BMJ Open Respir Res 2020;7:e000712. https://doi.org/10.1136/bmjresp-2020-000712
  20. Pisani L, Betti S, Biglia C, Fasano L, Catalanotti V, Prediletto I, et al. Effects of high-flow nasal cannula in patients with persistent hypercapnia after an acute COPD exacerbation: a prospective pilot study. BMC Pulm Med 2020;20:12. https://doi.org/10.1186/s12890-020-1048-7
  21. Pisani L, Fasano L, Corcione N, Comellini V, Musti MA, Brandao M, et al. Change in pulmonary mechanics and the effect on breathing pattern of high flow oxygen therapy in stable hypercapnic COPD. Thorax 2017;72:373-5. https://doi.org/10.1136/thoraxjnl-2016-209673
  22. Braunlich J, Mauersberger F, Wirtz H. Effectiveness of nasal highflow in hypercapnic COPD patients is flow and leakage dependent. BMC Pulm Med 2018;18:14. https://doi.org/10.1186/s12890-018-0576-x
  23. Braunlich J, Dellweg D, Bastian A, Budweiser S, Randerath W, Triche D, et al. Nasal high-flow versus noninvasive ventilation in patients with chronic hypercapnic COPD. Int J Chron Obstruct Pulmon Dis 2019;14:1411-21. https://doi.org/10.2147/COPD.S206111
  24. Braunlich J, Seyfarth HJ, Wirtz H. Nasal high-flow versus non-invasive ventilation in stable hypercapnic COPD: a preliminary report. Multidiscip Respir Med 2015;10:27. https://doi.org/10.1186/s40248-015-0019-y
  25. Weinreich UM, Storgaard LH. A real-life study of combined treatment with long-term non-invasive ventilation and high flow nasal cannula in patients with end-stage chronic obstructive lung disease. J Clin Med 2023;12:4485. https://doi.org/10.3390/jcm12134485
  26. Fraser JF, Spooner AJ, Dunster KR, Anstey CM, Corley A. Nasal high flow oxygen therapy in patients with COPD reduces respiratory rate and tissue carbon dioxide while increasing tidal and end-expiratory lung volumes: a randomized crossover trial. Thorax 2016;71:759-61. https://doi.org/10.1136/thoraxjnl-2015-207962
  27. Weinreich UM. Domiciliary high-flow treatment in patients with COPD and chronic hypoxic failure: in whom can we reduce exacerbations and hospitalizations? PLoS One 2019;14:e0227221. https://doi.org/10.1371/journal.pone.0227221
  28. Good WR, Garrett J, Hockey HU, Jayaram L, Wong C, Rea H. The role of high-flow nasal therapy in bronchiectasis: a post hoc analysis. ERJ Open Res 2021;7:00711-2020. https://doi.org/10.1183/23120541.00711-2020
  29. Crimi C, Nolasco S, Campisi R, Nigro M, Impellizzeri P, Cortegiani A, et al. Long-term domiciliary high-flow nasal therapy in patients with bronchiectasis: a preliminary retrospective observational case-control study. J Clin Med 2022;11:7323. https://doi.org/10.3390/jcm11247323
  30. Weinreich UM, Burchardt C, Huremovic J. The effect of domiciliary high flow nasal cannula treatment on dyspnea and walking distance in patients with interstitial lung disease: a pilot study. Chron Respir Dis 2022;19:14799731221137085. https://doi.org/10.1177/14799731221137085
  31. Yanagita Y, Arizono S, Yokomura K, Ito K, Machiguchi H, Tawara Y, et al. Enhancing exercise tolerance in interstitial lung disease with high-flow nasal cannula oxygen therapy: a randomized crossover trial. Respirology 2024;29:497-504. https://doi.org/10.1111/resp.14684
  32. Milne RJ, Hockey HU, Garrett J. Hospital cost savings for sequential COPD patients receiving domiciliary nasal high flow therapy. Int J Chron Obstruct Pulmon Dis 2022;17:1311-22. https://doi.org/10.2147/COPD.S350267
  33. Groessl EJ, Tally SR, Hillery N. Cost-effectiveness of humidified high-flow therapy (HHFT) for COPD patients on long-term oxygen therapy. Clinicoecon Outcomes Res 2023;15:239-50. https://doi.org/10.2147/CEOR.S400739
  34. Hasani A, Chapman TH, McCool D, Smith RE, Dilworth JP, Agnew JE. Domiciliary humidification improves lung mucociliary clearance in patients with bronchiectasis. Chron Respir Dis 2008;5:81-6. https://doi.org/10.1177/1479972307087190
  35. Hui D, Mahler DA, Larsson L, Wu J, Thomas S, Harrison CA, et al. High-flow nasal cannula therapy for exertional dyspnea in patients with cancer: a pilot randomized clinical trial. Oncologist 2021;26:e1470-9. https://doi.org/10.1002/onco.13624
  36. Harada J, Nagata K, Morimoto T, Iwata K, Matsunashi A, Sato Y, et al. Effect of high-flow nasal cannula oxygen therapy on exercise tolerance in patients with idiopathic pulmonary fibrosis: a randomized crossover trial. Respirology 2022;27:144-51. https://doi.org/10.1111/resp.14176
  37. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (2024 report) [Internet]. Deer Park: GOLD; 2024 [cited 2025 Mar 5]. Available from: https://goldcopd.org/2024-goldreport.
  38. Nishimura M. High-flow nasal cannula oxygen therapy devices. Respir Care 2019;64:735-42. https://doi.org/10.4187/respcare.06718
  39. Spoletini G, Alotaibi M, Blasi F, Hill NS. Heated humidified high-flow nasal oxygen in adults: mechanisms of action and clinical implications. Chest 2015;148:253-61. https://doi.org/10.1378/chest.14-2871
  40. D'Cruz RF, Hart N, Kaltsakas G. High-flow therapy: physiological effects and clinical applications. Breathe (Sheff) 2020;16:200224. https://doi.org/10.1183/20734735.0224-2020
  41. Moller W, Feng S, Domanski U, Franke KJ, Celik G, Bartenstein P, et al. Nasal high flow reduces dead space. J Appl Physiol (1985) 2017;122:191-7. https://doi.org/10.1152/japplphysiol.00584.2016
  42. Bazuaye EA, Stone TN, Corris PA, Gibson GJ. Variability of inspired oxygen concentration with nasal cannulas. Thorax 1992;47:609-11. https://doi.org/10.1136/thx.47.8.609
  43. Puddy A, Younes M. Effect of inspiratory flow rate on respiratory output in normal subjects. Am Rev Respir Dis 1992;146:787-9. https://doi.org/10.1164/ajrccm/146.3.787
  44. Chatila W, Nugent T, Vance G, Gaughan J, Criner GJ. The effects of high-flow vs low-flow oxygen on exercise in advanced obstructive airways disease. Chest 2004;126:1108-15. https://doi.org/10.1378/chest.126.4.1108
  45. Sztrymf B, Messika J, Bertrand F, Hurel D, Leon R, Dreyfuss D, et al. Beneficial effects of humidified high flow nasal oxygen in critical care patients: a prospective pilot study. Intensive Care Med 2011;37:1780-6. https://doi.org/10.1007/s00134-011-2354-6
  46. Cirio S, Piran M, Vitacca M, Piaggi G, Ceriana P, Prazzoli M, et al. Effects of heated and humidified high flow gases during high-intensity constant-load exercise on severe COPD patients with ventilatory limitation. Respir Med 2016;118:128-32. https://doi.org/10.1016/j.rmed.2016.08.004
  47. Mundel T, Feng S, Tatkov S, Schneider H. Mechanisms of nasal high flow on ventilation during wakefulness and sleep. J Appl Physiol (1985) 2013;114:1058-65. https://doi.org/10.1152/japplphysiol.01308.2012
  48. Zhang L, Wang Y, Ye Y, Gao J, Zhu F, Min L. Comparison of high-flow nasal cannula with conventional oxygen therapy in patients with hypercapnic chronic obstructive pulmonary disease: a systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis 2023;18:895-906. https://doi.org/10.2147/COPD.S402506
  49. Wanner A, Salathe M, O'Riordan TG. Mucociliary clearance in the airways. Am J Respir Crit Care Med 1996;154(6 Pt 1):1868-902. https://doi.org/10.1164/ajrccm.154.6.8970383
  50. Fahy JV, Dickey BF. Airway mucus function and dysfunction. N Engl J Med 2010;363:2233-47. https://doi.org/10.1056/NEJMra0910061
  51. Williams R, Rankin N, Smith T, Galler D, Seakins P. Relationship between the humidity and temperature of inspired gas and the function of the airway mucosa. Crit Care Med 1996;24:1920-9. https://doi.org/10.1097/00003246-199611000-00025
  52. Park S. High-flow nasal cannula for respiratory failure in adult patients. Acute Crit Care 2021;36:275-85. https://doi.org/10.4266/acc.2021.01571
  53. Dery R. Humidity in anaesthesiology: IV. determination of the alveolar humidity and temperature in the dog. Can Anaesth Soc J 1971;18:145-51. https://doi.org/10.1007/BF03025443
  54. Mauri T, Turrini C, Eronia N, Grasselli G, Volta CA, Bellani G, et al. Physiologic effects of high-flow nasal cannula in acute hypoxemic respiratory failure. Am J Respir Crit Care Med 2017;195:1207-15. https://doi.org/10.1164/rccm.201605-0916OC
  55. Groves N, Tobin A. High flow nasal oxygen generates positive airway pressure in adult volunteers. Aust Crit Care 2007;20:126-31. https://doi.org/10.1016/j.aucc.2007.08.001
  56. Parke R, McGuinness S, Eccleston M. Nasal high-flow therapy delivers low level positive airway pressure. Br J Anaesth 2009;103:886-90. https://doi.org/10.1093/bja/aep280
  57. Parke RL, McGuinness SP. Pressures delivered by nasal high flow oxygen during all phases of the respiratory cycle. Respir Care 2013;58:1621-4. https://doi.org/10.4187/respcare.02358
  58. Kent BD, Mitchell PD, McNicholas WT. Hypoxemia in patients with COPD: cause, effects, and disease progression. Int J Chron Obstruct Pulmon Dis 2011;6:199-208.
  59. Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial: nocturnal oxygen therapy trial group. Ann Intern Med 1980;93:391-8. https://doi.org/10.7326/0003-4819-93-3-391
  60. Long term domiciliary oxygen therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis and emphysema: report of the medical research council working party. Lancet 1981;1:681-6. https://doi.org/10.1016/S0140-6736(81)91970-X
  61. Morrison DA, Stovall JR. Increased exercise capacity in hypoxemic patients after long-term oxygen therapy. Chest 1992;102:542-50. https://doi.org/10.1378/chest.102.2.542
  62. Wedzicha JA. Effects of long-term oxygen therapy on neuropsychiatric function and quality of life. Respir Care 2000;45:119-26.
  63. Eaton T, Lewis C, Young P, Kennedy Y, Garrett JE, Kolbe J. Long-term oxygen therapy improves health-related quality of life. Respir Med 2004;98:285-93. https://doi.org/10.1016/j.rmed.2003.10.008
  64. Zielinski J, Tobiasz M, Hawrylkiewicz I, Sliwinski P, Pałasiewicz G. Effects of long-term oxygen therapy on pulmonary hemodynamics in COPD patients: a 6-year prospective study. Chest 1998;113:65-70. https://doi.org/10.1378/chest.113.1.65
  65. Nilius G, Franke KJ, Domanski U, Ruhle KH, Kirkness JP, Schneider H. Effects of nasal insufflation on arterial gas exchange and breathing pattern in patients with chronic obstructive pulmonary disease and hypercapnic respiratory failure. Adv Exp Med Biol 2013;755:27-34. https://doi.org/10.1007/978-94-007-4546-9_4
  66. Murray MP, Turnbull K, MacQuarrie S, Pentland JL, Hill AT. Validation of the Leicester cough questionnaire in non-cystic fibrosis bronchiectasis. Eur Respir J 2009;34:125-31. https://doi.org/10.1183/09031936.00160508
  67. Chalmers JD, Smith MP, McHugh BJ, Doherty C, Govan JR, Hill AT. Short- and long-term antibiotic treatment reduces airway and systemic inflammation in non-cystic fibrosis bronchiectasis. Am J Respir Crit Care Med 2012;186:657-65. https://doi.org/10.1164/rccm.201203-0487OC
  68. Sotello D, Rivas M, Mulkey Z, Nugent K. High-flow nasal cannula oxygen in adult patients: a narrative review. Am J Med Sci 2015;349:179-85. https://doi.org/10.1097/MAJ.0000000000000345
  69. Braunlich J, Kohler M, Wirtz H. Nasal high-flow (NHF) improves ventilation in patients with interstitial lung disease(ILD): a physiological study. J Clin Med 2023;12:5853. https://doi.org/10.3390/jcm12185853
  70. Faverio P, De Giacomi F, Bonaiti G, Stainer A, Sardella L, Pellegrino G, et al. Management of chronic respiratory failure in interstitial lung diseases: overview and clinical insights. Int J Med Sci 2019;16:967-80. https://doi.org/10.7150/ijms.32752
  71. Chang Y, Kim TG, Chung SY. High-flow nasal cannula-in-duced tension pneumocephalus. Indian J Crit Care Med 2020;24:592-5. https://doi.org/10.5005/jp-journals-10071-23482
  72. Chikata Y, Izawa M, Okuda N, Itagaki T, Nakataki E, Onodera M, et al. Humidification performance of two highflow nasal cannula devices: a bench study. Respir Care 2014;59:1186-90. https://doi.org/10.4187/respcare.02932
  73. Chikata Y, Morinishi K, Nishimura M. Humidification in very-high-flow nasal-cannula therapy in an adult lung model. Respir Care 2019;64:809-17. https://doi.org/10.4187/respcare.06417
  74. Pisani L, Vega ML. Use of nasal high flow in stable COPD: rationale and physiology. COPD 2017;14:346-50. https://doi.org/10.1080/15412555.2017.1315715
  75. Maggiore SM, Idone FA, Vaschetto R, Festa R, Cataldo A, Antonicelli F, et al. Nasal high-flow versus Venturi mask oxygen therapy after extubation: effects on oxygenation, comfort, and clinical outcome. Am J Respir Crit Care Med 2014;190:282-8. https://doi.org/10.1164/rccm.201402-0364OC
  76. Nishimura M. High-flow nasal cannula oxygen therapy in adults. J Intensive Care 2015;3:15. https://doi.org/10.1186/s40560-015-0084-5
  77. Weinreich UM, Juhl KS, Soby Christophersen M, Gundestrup S, Hanifa MA, Jensen K, et al. The Danish Respiratory Society guideline for long-term high flow nasal cannula treatment, with or without supplementary oxygen. Eur Clin Respir J.2023;10:2178600. https://doi.org/10.1080/20018525.2023.2178600
  78. Storgaard LH, Weinreich UM, Laursen BS. COPD patients' experience of long-term domestic oxygen-enriched nasal high flow treatment: a qualitative study. COPD 2020;17:175-83. https://doi.org/10.1080/15412555.2020.1736998
  79. Criner GJ, Criner LH, George SA, Thomas JK, Jacobs MR. Feasibility of using daily home high-flow nasal therapy in COPD patients following a recent COPD hospitalization. Chronic Obstr Pulm Dis 2022;9:4-14. https://doi.org/10.15326/jcopdf.2021.0236
  80. Elshof J, Duiverman ML. Clinical evidence of nasal highflow therapy in chronic obstructive pulmonary disease patients. Respiration 2020;99:140-53. https://doi.org/10.1159/000505583
  81. Park YB, Rhee CK, Yoon HK, Oh YM, Lim SY, Lee JH, et al. Revised (2018) COPD clinical practice guideline of the Korean Academy of Tuberculosis and Respiratory Disease: a summary. Tuberc Respir Dis (Seoul) 2018;81:261-73. https://doi.org/10.4046/trd.2018.0029