Can High Flow Nasal Cannula (HFNC) be used for long-term oxygen therapy, such as a year or more?

Can HFNC Be Used Long-Term (e.g., One Year or More)?

HFNC is designed and evidence-supported exclusively for acute respiratory failure management, not for long-term use extending to a year or more. 1

Evidence Base and Intended Use

The European Respiratory Society guidelines explicitly address HFNC as an intervention for acute respiratory failure (ARF) in adults, with all recommendations focused on acute settings including hypoxemic respiratory failure, post-operative care, and post-extubation support. 1 The evidence base consists entirely of studies evaluating HFNC in acute scenarios, with no trials examining chronic use beyond weeks. 1

Duration of Use in Clinical Practice

• Acute phase treatment: HFNC is typically used for days to weeks during acute illness, with the goal of stabilizing patients and transitioning to conventional oxygen therapy (COT) or weaning off support entirely. 2

• Post-extubation support: Even in high-risk scenarios, HFNC is maintained for only 24-48 hours before considering transition to COT. 2

• Weaning timeline: Patients should demonstrate stability on HFNC for 12-24 hours before attempting transition, with flow rates reduced to ≤30 L/min and FiO2 ≤0.35-0.40 before switching to conventional oxygen. 2

Why HFNC Is Not Suitable for Long-Term Use

Resource and Practical Limitations

• High oxygen consumption: HFNC delivers flow rates up to 60 L/min, consuming substantially more oxygen than conventional therapy, making sustained use impractical and costly. 1, 3

• Equipment requirements: The device requires continuous heated humidification at 37°C with 100% relative humidity, specialized equipment, and regular maintenance. 3

• Monitoring needs: HFNC requires continuous or frequent monitoring in ICU, intermediate care, or high-dependency units—settings inappropriate for year-long therapy. 1, 3

Clinical Considerations

• Risk of delayed escalation: Prolonged noninvasive respiratory support with HFNC in patients who are failing may result in delayed intubation and worse hospital mortality. 1

• Patient selection issues: The guidelines emphasize that HFNC benefits patients at high risk of intubation during acute illness, not those with stable chronic respiratory insufficiency. 1

Alternative for Chronic Respiratory Support

For patients requiring long-term oxygen therapy (months to years), conventional oxygen therapy or long-term oxygen therapy (LTOT) systems are the appropriate interventions. 2

When Chronic Support Is Needed

• Patients with chronic respiratory diseases and persistent respiratory insufficiency should receive conventional oxygen therapy via nasal cannula (typically 2-6 L/min) or other low-flow devices. 2

• Long-term home oxygen therapy is well-established for conditions like COPD, interstitial lung disease, and chronic hypoxemic respiratory failure, with evidence supporting mortality benefits. 4

• Domiciliary NIV (noninvasive ventilation) may be considered for patients with chronic hypercapnic respiratory failure, such as stable COPD with elevated CO2. 4

Critical Pitfall to Avoid

Do not confuse acute HFNC therapy with chronic oxygen therapy needs. If a patient has been on HFNC for more than a few weeks, reassess whether:

1. The acute process has resolved and the patient can transition to COT. 2
2. The patient has chronic respiratory failure requiring long-term oxygen therapy (not HFNC). 4
3. The patient needs escalation to NIV or mechanical ventilation due to treatment failure. 1

The maximum reasonable duration for HFNC would be weeks during a prolonged acute illness or recovery phase, not months or years. 1, 2